Age-of-onset or behavioral sub-types? A prospective comparison of two approaches to characterizing the heterogeneity within antisocial behavior

Psychometric properties of a short self-report measure of rule-breaking behaviour among adolescents: findings from the Ungdata survey

BACKGROUND

The aim of the present study was to examine the factor structure and reliability of a six-item scale of rule-breaking behaviour, and to test for measurement invariance across gender, age, survey year and geographical location.

METHODS

Data were from three yearly cross-sectional and population-based collections of the Ungdata surveys (2017 to 2019) including a total of 297,102 Norwegian adolescents aged approximately 13 to 19 years. Measurements included respondent's rule-breaking behaviour, time, gender, age and geographical location.

RESULTS

Confirmatory factor analyses demonstrated that a one-factor solution of the rule-breaking behaviour scale had good fit to data (comparative fit index 0.98; Tucker-Lewis index 0.96; root mean square error of approximation 0.049 (95% confidence interval 0.048, 0.050)), with factor loadings ranging from 0.60 to 0.81 for all items (mean factor loading 0.72). Similar results were found across survey years for both genders. Several multiple group confirmatory factor analyses showed indications of measurement invariance for the scale across gender, age groups, geographical locations and survey years. The ordinal alpha and omega coefficients for internal consistency of the scale were both 0.86.

CONCLUSIONS

The six-item scale for self-reported rule-breaking behaviour demonstrated good psychometric properties and appears to constitute a reliable measure of adolescent rule-breaking behaviour for use in population-based surveys in a Norwegian setting.

Neuroanatomical markers of familial risk in adolescents with conduct disorder and their unaffected relatives

BACKGROUND

Previous studies have reported brain structure abnormalities in conduct disorder (CD), but it is unclear whether these neuroanatomical alterations mediate the effects of familial (genetic and environmental) risk for CD. We investigated brain structure in adolescents with CD and their unaffected relatives (URs) to identify neuroanatomical markers of familial risk for CD.

METHODS

Forty-one adolescents with CD, 24 URs of CD probands, and 38 healthy controls (aged 12-18), underwent structural magnetic resonance imaging. We performed surface-based morphometry analyses, testing for group differences in cortical volume, thickness, surface area, and folding. We also assessed the volume of key subcortical structures.

RESULTS

The CD and UR groups both displayed structural alterations (lower surface area and folding) in left inferior parietal cortex compared with controls. In contrast, CD participants showed lower insula and pars opercularis volume than controls, and lower surface area and folding in these regions than controls and URs. The URs showed greater folding in rostral anterior cingulate and inferior temporal cortex than controls and greater medial orbitofrontal folding than CD participants. The surface area and volume differences were not significant when controlling for attention-deficit/hyperactivity disorder comorbidity. There were no group differences in subcortical volumes.

CONCLUSIONS

These findings suggest that alterations in inferior parietal cortical structure partly mediate the effects of familial risk for CD. These structural changes merit investigation as candidate endophenotypes for CD. Neuroanatomical changes in medial orbitofrontal and anterior cingulate cortex differentiated between URs and the other groups, potentially reflecting neural mechanisms of resilience to CD.

Empirically based dimensions of externalizing symptoms in children and adolescents: a multitrait-multisource approach

The present study sought to refine knowledge about the structure underlying externalizing dimensions. From a “top-down” ICD/DSM-based perspective, externalizing symptoms can be categorized into attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD). From a “bottom-up” developmental theory-based perspective, disruptive behaviors can be meaningfully described as aggressive (AGG) and rule-breaking (RB) behaviors. We analyzed five large data sets comprising externalizing symptom ratings obtained with a screening instrument using different sources (parents, teachers, self-ratings) from different samples. Using confirmatory factor analyses, we evaluated several factor models (unidimensional; correlated factors; bifactor (S-1) models) derived from an ICD/DSM- and theory-based perspective. Our optimally fitting models were assessed for measurement invariance across all sources, sample settings, and sex. Following several model-based criteria (model fit indices; factor loadings; omega statistics; model parsimony), we discarded our models stepwise and concluded that both the ICD/DSM-based model with three correlated factors (ADHD, ODD, CD) and the developmental theory-based model with three correlated factors (ADHD, AGG, RB) displayed a statistically sound factor structure and allowed for straightforward interpretability. Furthermore, these two models demonstrated metric invariance across all five samples and across sample settings (community, clinical), as well as scalar invariance across sources and sex. While the dimensions AGG and RB may depict a more empirically coherent view than the categorical perspective of ODD and CD, at this point we cannot clearly determine whether one perspective really outperforms the other. Implications for model selection according to our model-based criteria and clinical research are discussed.

The Genetic, Environmental, and Cultural Forces Influencing Youth Antisocial Behavior Are Tightly Intertwined

The aggressive and rule-breaking behaviors that constitute youth antisocial behavior (ASB) are shaped by intertwined genetic, developmental, familial, spatial, temporal, cultural, interpersonal, and contextual influences operating across multiple levels of analysis. Genetic influences on ASB, for example, manifest in different ways during different developmental periods, and do so in part as a function of exposure to harsh parenting, delinquent peers, and disadvantaged neighborhoods. There is also clear evidence documenting societal effects, time-period effects, sex-assigned-at-birth effects, and cohort effects, all of which point to prominent (and possibly interconnected) cultural influences on ASB. In short, ASB is shaped by individuals' current and prior environmental experiences, genetic risks, and the time and place in which they live. This review seeks to illuminate already documented instances of interplay among the multilevel etiologic forces impinging on youth ASB, with the goal of facilitating additional research.

Developmental Trajectories of Delinquent and Aggressive Behavior: Evidence for Differential Heritability

The developmental course of antisocial behavior is often described in terms of qualitatively distinct trajectories. However, the genetic etiology of various trajectories is not well understood. We examined heterogeneity in the development of delinquent and aggressive behavior in 1532 twin youth using four waves of data collection, spanning ages 9-10 to 16-18. A latent class growth analysis was used to uncover relevant subgroups. For delinquent behavior, three latent classes emerged: Non-Delinquent, Low-Level Delinquent, and Persistent Delinquent. Liability for persistent delinquency had a substantial genetic origin (heritability = 67%), whereas genetic influences were negligible for lower-risk subgroups. Three classes of aggressive behavior were identified: Non-Aggressive, Moderate, and High. Moderate heritability spanned the entire continuum of risk for aggressive behavior. Thus, there are differences between aggressive behavior and non-aggressive delinquency with respect to heterogeneity of etiology. We conclude that persistent delinquency represents an etiologically distinct class of rule-breaking with strong genetic roots.

Individual differences in the development of youth externalizing problems predict a broad range of adult psychosocial outcomes

This study examined how youth aggressive and delinquent externalizing problem behaviors across childhood and adolescence are connected to consequential psychosocial life outcomes in adulthood. Using data from a longitudinal, high-risk sample (N = 1069) that assessed children and their parents regularly from early childhood (ages 3-5) through adulthood, multilevel growth factors of externalizing behaviors were used to predict adult outcomes (age 24-31), providing a sense of how externalizing problems across development were related to these outcomes via maternal, paternal, teacher, and child report. Findings indicated strong support for the lasting connections between youth externalizing problems with later educational attainment and legal difficulties, spanning informants and enduring beyond other meaningful contributors (i.e., child sex, cognitive ability, parental income and education, parental mental health and relationship quality). Some support was also found, although less consistently, linking externalizing problems and later alcohol use as well as romantic relationship quality. Delinquent/rule-breaking behaviors were often stronger predictors of later outcomes than aggressive behaviors. Taken together, these results indicate the importance of the role youth externalizing behaviors have in adult psychosocial functioning one to two decades later.

Changes over time in mental health symptoms among adolescents in Tampere, Finland

Background:

Mental health problems are common in adolescence and seeking help for them is becoming more common. Referrals to adolescent mental healthcare have recently increased in Finland.

Objective:

To examine time trends in internalizing and externalizing mental health symptoms among Finnish adolescents.

Method:

A time-trend school survey was conducted among 9^th graders (15-year-olds) in Tampere, Finland, in three time periods: 2002–03, 2012–13 and 2018–19 (N = 4,162).

Results:

Compared to the period 2002–03, prevalence of externalizing symptoms decreased in the period 2012–13 and further in 2018–19. The prevalence of internalizing symptoms did not change significantly between 2002–03 and 2012–13; however, in 2018–19, depression, social anxiety, general anxiety, poor subjective health, stress symptoms among boys, and poor self-esteem increased compared to earlier time periods. The increases were more marked among girls. However, suicidal ideation did not increase in 2018–19 compared to earlier time periods.

Conclusion:

Whereas the prevalence of externalizing symptoms decreased among Finnish adolescents between 2002–03 and 2018–19, the prevalence of internalizing symptoms increased between 2012–13 and 2018–19. To help to understand the causes of these increases and to prevent internalizing problems, further research on the underlying causes is needed.

Multiple developmental pathways underlying conduct problems: A multitrajectory framework

In the past decades, there has been an overemphasis of a descriptive/behavioral approach to study conduct disorder. In an equifinal perspective, we aimed to examine the developmental multitrajectory groups of psychological features (irritability, interpersonal callousness, hyperactivity/impulsivity, and depressive-anxiety symptoms) and their associations with conduct problems. In a population-based cohort (n = 1,309 participants followed from 5 months to 17 years old), latent-class growth analysis was performed for each psychological feature to identify a two-trajectory model (from ages 6 to 12 years). Based on parameter estimates of the two-trajectory models for each of the four psychological features, a parallel process growth mixture model identified eight significant developmental patterns that were subsequently compared with typically developing children. Furthermore, we observed that while interpersonal callousness conferred an increased risk for childhood and adolescence conduct problems, its co-occurrence with hyperactivity/impulsivity, irritability, and/or depressive-anxiety symptoms heightened the general risk, but also predicted distinct subtypes of conduct problems (i.e., aggressive and rule-breaking behaviors). Thus, by studying complex developmental combinations of psychological features, we observed qualitatively distinct pathways towards conduct problems. A multitrajectory framework of psychological features should be considered as a significant step towards unveiling the multiple etiological pathways leading to conduct disorder and its substantial clinical heterogeneity.

Neural Correlates of Empathy in Boys With Early Onset Conduct Disorder

Background: A deficit in empathy has repeatedly been described in individuals with conduct disorder (CD), and in particular in those with callous unemotional traits. Until now, little is known about the neural basis of empathy in children and adolescents with early onset conduct disorder. The aim of this study was to examine neural responses during empathizing in children and adolescents with CD with a task that allowed to differentiate between the judgment of the emotional states of other people and the own emotional response to other people's emotional state. Moreover, we investigated associations of callous-unemotional traits and neural activations during empathizing. Methods: Using functional magnetic resonance imaging (fMRI) we investigated 14 boys with early onset CD and 15 typically developing (TDC) age matched controls between 8 and 16 years of age. Happy and sad faces were presented, and participants were asked to either infer the emotional state from the face (other-task) or to judge their own emotional response (self-task). A perceptual decision on faces was used as a control task. Individual empathic abilities and callous unemotional traits were assessed. Results: During the other task, TDC boys showed significantly larger right amygdala responses than CD boys. Higher empathic abilities (as assessed with the Bryant Index of Empathy) were associated with higher responses in the right amygdala within the CD boys and across the entire sample. Moreover, across the entire sample, callous-unemotional traits were negatively related to the BOLD-response in the right amygdala. CD boys showed larger responses in the dorsal and ventral medial prefrontal cortex across tasks and increased activation in dorsal medial prefrontal cortex specifically during the self-conditions, which were also related to empathic abilities within the CD boys. Conclusions: The data emphasize the important role of the amygdala in empathy related emotional processing. Diminished amygdala responses and their association with low empathy suggest a pivotal influence of impaired amygdala processing in early-onset CD, in particular for deficits in empathic behavior and related callous-unemotional-traits. Elevated response in the medial prefrontal cortex in boys with CD point toward increased involvement of brain areas related to self-referential processing and cognitive empathy during empathizing.

The validity of conduct disorder symptom profiles in high-risk male youth

Conduct disorder (CD) is a heterogeneous pattern of rule-breaking and aggressive symptoms. Until now it has been unclear whether valid, clinically useful symptom profiles can be defined for populations in youth at high-risk of CD. Interview-based psychiatric disorders, CD symptoms and officially recorded offences were assessed in boys from a detention facility and a forensic psychiatric hospital (N = 281; age 11.2-21.3 years). We used latent class analyses (LCA) to examine CD subtypes and their relationships with comorbid psychiatric disorders, suicidality, and criminal recidivism. LCA revealed five CD subtypes: no CD, mild aggressive CD, mild covert CD, moderate CD, and severe CD. The severe and, to a lesser degree, the moderate CD subtype were related to comorbid attention deficit hyperactivity disorder, substance use disorder, affective disorder, and suicidality. Time to violent criminal re-offending was predicted by severe CD (OR 5.98, CI 2.5-13.80) and moderate CD (OR 4.18, CI 1.89-9.21), but not by any other CD subtype in multivariate Cox regressions (controlling for age, low socioeconomic status and foreign nationality). These results confirm the existence of different CD symptom profiles in a high-risk group. Additional variable-oriented analyses with CD symptom count and aggressive/rule-breaking CD-dimensions further supported a dimensional view and a dose-response relationship of CD and criminal recidivism. Classifying high-risk young people according to the number of aggressive and rule-breaking CD symptoms is of major clinical importance and may provide information about risk of violent recidivism.

Risky business! Behavioral bias and motivational salience of rule-violations in children with conduct disorder

Conduct disorder is characterized by both habitual aggression as well as non-aggressive rule-breaking behavior. While a large body of research has focused on aggressive behavior to date, the subtype of non-aggressive rule-breaking behavior is poorly understood. The current study represents a first attempt to directly assess decision biases toward rule-breaking behavior, their motivational salience, and the association with interpersonal factors in conduct disorder. Participants (n = 20 children with conduct disorder and n = 20 healthy controls) played a video game with the goal to deliver a hot pizza by bicycle to a marked location on a two-dimensional city map. In each trial, participants decided whether to use the regular route (streets) or opt for a potential shortcut that was either permitted (bicycle lane) or prohibited (park). The efficiency of the shortcut was parametrically varied to assess individual decision functions. Consistent with our hypotheses, group differences emerged only when taking a shortcut represented a rule violation (park condition), with the conduct disorder group committing significantly more rule violations than controls. Furthermore, conduct disorder children showed a substantial frequency of rule violations even in the absence of shortcut related gains, indicating a pronounced insensitivity towards sanctions. Importantly, this tendency was associated with self-reported impulsivity and rule violations in real life.

Predictors of adult outcomes in clinically- and legally-ascertained youth with externalizing problems

Externalizing problems (EP), including rule-breaking, aggression, and criminal involvement, are highly prevalent during adolescence, but the adult outcomes of adolescents exhibiting EP are characterized by heterogeneity. Although many youths' EP subside after adolescence, others' persists into adulthood. Characterizing the development of severe EP is essential to prevention and intervention efforts. Multiple predictors of adult antisocial personality disorder (ASPD) and legal outcomes of a large sample (N = 1205) of clinically- or legally-ascertained adolescents (ages 12-19 years) with severe EP were examined. Many psychosocial predictors hypothesized to predict persistence of EP demonstrated zero-order associations with adult outcomes, but accounted for little unique variation after accounting for baseline conduct disorder symptoms (CD) and demographic factors. Baseline measures of intelligence, which explained independent variation in legal outcomes, provided the only consistent exception to this pattern, though future work is needed to parse these effects from those of socioeconomic factors. CD severity during adolescence is a parsimonious index of liability for persistence of EP into adulthood that explains outcome variance above and beyond all other demographic and psychosocial predictors in this sample.

Are there sex differences in the etiology of youth antisocial behavior?

Sex differences in the etiology of youth antisocial behavior are an intuitively appealing hypothesis given the consistently higher prevalence of antisocial behavior in boys versus girls. Although a few early studies supported this possibility, reporting stronger genetic influences in females and stronger environmental influences in males, subsequent meta-analyses found that antisocial behavior was equally heritable in males and females. Critically however, none of the meta-analyses evaluated whether sex differences in etiology might be enhanced in particular subpopulations or contexts. The current study sought to do just this. We examined 1,030 child twin pairs from the Michigan State University Twin Registry, half of whom were oversampled for neighborhood disadvantage, thereby allowing us to meaningfully evaluate whether sex differences in etiology were enhanced in disadvantaged contexts. We also directly evaluated the possibility of sex differences in the etiology of teacher- versus maternal-informant reports of antisocial behavior, evaluating each informant-report for possible sex differences. Results were not consistent with differential effects of sex on etiology in disadvantaged versus advantaged contexts, but did suggest moderation by informant-report. Namely, genetic influences were stronger in girls, and environmental influences were stronger in boys, when antisocial behavior was assessed using teacher informant-reports, but not when assessed using maternal informant-reports. Critically, these findings were confirmed when we reanalyzed meta-analytic data from Burt (2009a) separately by informant. Such findings suggest that, at least in school contexts, the etiology of antisocial behavior does indeed vary across sex. Implications are discussed. (PsycINFO Database Record

Clinically differentiating life-course-persistent and adolescence-limited conduct problems: Is age-of-onset really enough?

One important subtyping of behavior problems is Moffitt's (1993) "life-course-persistent" (LCP) and "adolescent limited" (AL) categories of antisocial behavior, which she differentiated in terms of high impulsivity, poor academic performance, and aggression. These problems may be exacerbated by the cumulative effects of chronic stress. Copious evidence has documented validity and developmental differences between these subtypes, whereas far fewer data exist regarding their clinical utility, in spite of the Diagnostic and Statistical Manual's nomenclature including corresponding subtypes based on age-of-onset of behavioral symptoms. The present study evaluated how well age-of-onset based subtyping identifies distinct developmental patterns of antisocial behavior corresponding to Moffitt's subtypes in terms of risk factors and gender between LCP and AL in a prospective sample of chronically stressed youth. A computerized assessment tool (ALEXSA©) was used to obtain data from 1,147 youth aged 8-16. Implications for clinical assessment and intervention strategy, particularly with stressed youth, are discussed.

Developmental Trajectories of Youth Conduct Problems: Testing Later Development and Related Outcomes in a 12-Year Period

Developmental heterogeneity of youth conduct problems has been widely assumed, leading to the identification of distinctive groups at particular risk of more serious problems later in development. The present study intends to expand the main results of a prior study focused on identifying developmental trajectories of conduct problems (Stable-low, Stable-high, and Decreasing), by analyzing their developmental course and related outcomes during middle/late adolescence and early adulthood. Two follow-up studies were conducted 10 and 12 years after the initial study with 115 and 122 youths respectively (mean = 17.29 and 19.18). Overall results underline that the Early-onset persistent group showed the highest risk-profile; the Childhood-limited group revealed a moderate level of later maladjustment; and the Adolescence-onset group, currently identified, showed a significant peak of risk particularly in middle/late adolescence. These findings provide a more comprehensive representation of youth conduct problems, and open new means of discussion in terms of preventive intervention.

Blunted Ambiguity Aversion During Cost-Benefit Decisions in Antisocial Individuals

Antisocial behavior is often assumed to reflect aberrant risk processing. However, many of the most significant forms of antisocial behavior, including crime, reflect the outcomes of decisions made under conditions of ambiguity rather than risk. While risk and ambiguity are formally distinct and experimentally dissociable, little is known about ambiguity sensitivity in individuals who engage in chronic antisocial behavior. We used a financial decision-making task in a high-risk community-based sample to test for associations between sensitivity to ambiguity, antisocial behavior, and arrest history. Sensitivity to ambiguity was lower in individuals who met diagnostic criteria for Antisocial Personality Disorder. Lower ambiguity sensitivity was also associated with higher externalizing (but not psychopathy) scores, and with higher levels of aggression (but not rule-breaking). Finally, blunted sensitivity to ambiguity also predicted a greater frequency of arrests. Together, these data suggest that alterations in cost-benefit decision-making under conditions of ambiguity may promote antisocial behavior.

Life course persistent and adolescence limited conduct disorder in a nationally representative US sample: prevalence, predictors, and outcomes

PURPOSE

The course of conduct disorder (CD) is heterogeneous. Moffitt proposed the heuristic of life course persistent (LCP) and adolescence limited (AL) to differentiate etiologically distinct forms of antisocial behavior (AB), each with distinct predictors and consequences, although a few studies have assessed this demarcation within the context of CD. The objective of this study was to apply Moffitt's taxonomy in a nationally representative US sample to investigate the prevalence, predictors, and outcomes of LCP and AL CD.

METHODS

Data come from the Collaborative Psychiatric Epidemiology Studies, a set of population-based nationally representative cross-sectional surveys (N = 20,130). Predictors included harsh discipline, maternal and paternal closeness, poverty in childhood, history of learning disability, parental deviance, and nativity. Outcomes included substance use, employment status, education attainment, marital status, income level, and self-rated mental and physical health.

RESULTS

The prevalence of LCP and AL CD was 0.5 and 4.6%, respectively, for females, and 1.9 and 5.1%, respectively, for males. Low childhood SES [Odds Ratio (OR) = 3.49], lack of maternal closeness (OR = 2.50), and history of harsh discipline (OR = 2.17) increased odds of LCP group membership. The LCP group had higher odds of developing substance use disorders (OR = 2.00) relative to AL.

CONCLUSIONS

LCP CD is more strongly influenced by childhood environment and confers increased odds for substance use problems in adulthood relative to AL CD.

Mapping the structural organization of the brain in conduct disorder: replication of findings in two independent samples

BACKGROUND

Neuroimaging methods that allow researchers to investigate structural covariance between brain regions are increasingly being used to study psychiatric disorders. Structural covariance analyses are particularly well suited for studying disorders with putative neurodevelopmental origins as they appear sensitive to changes in the synchronized maturation of different brain regions. We assessed interregional correlations in cortical thickness as a measure of structural covariance, and applied this method to investigate the coordinated development of different brain regions in conduct disorder (CD). We also assessed whether structural covariance measures could differentiate between the childhood-onset (CO-CD) and adolescence-onset (AO-CD) subtypes of CD, which may differ in terms of etiology and adult outcomes.

METHODS

We examined interregional correlations in cortical thickness in male youths with CO-CD or AO-CD relative to healthy controls (HCs) in two independent datasets. The age range in the Cambridge sample was 16-21 years (mean: 18.0), whereas the age range of the Southampton sample was 13-18 years (mean: 16.7). We used FreeSurfer to perform segmentations and applied structural covariance methods to the resulting parcellations.

RESULTS

In both samples, CO-CD participants displayed a strikingly higher number of significant cross-cortical correlations compared to HC or AO-CD participants, whereas AO-CD participants presented fewer significant correlations than HCs. Group differences in the strength of the interregional correlations were observed in both samples, and each set of results remained significant when controlling for IQ and comorbid attention-deficit/hyperactivity disorder symptoms.

CONCLUSIONS

This study provides new evidence for quantitative differences in structural brain organization between the CO-CD and AO-CD subtypes, and supports the hypothesis that both subtypes of CD have neurodevelopmental origins.

Annual Research Review: Transdiagnostic neuroscience of child and adolescent mental disorders--differentiating decision making in attention-deficit/hyperactivity disorder, conduct disorder, depression, and anxiety

BACKGROUND

Ineffective decision making is a major source of everyday functional impairment and reduced quality of life for young people with mental disorders. However, very little is known about what distinguishes decision making by individuals with different disorders or the neuropsychological processes or brain systems underlying these. This is the focus of the current review.

SCOPE AND METHODOLOGY

We first propose a neuroeconomic model of the decision-making process with separate stages for the prechoice evaluation of expected utility of future options; choice execution and postchoice management; the appraisal of outcome against expectation; and the updating of value estimates to guide future decisions. According to the proposed model, decision making is mediated by neuropsychological processes operating within three domains: (a) self-referential processes involved in autobiographical reflection on past, and prospection about future, experiences; (b) executive functions, such as working memory, inhibition, and planning, that regulate the implementation of decisions; and (c) processes involved in value estimation and outcome appraisal and learning. These processes are underpinned by the interplay of multiple brain networks, especially medial and lateralized cortical components of the default mode network, dorsal corticostriatal circuits underpinning higher order cognitive and behavioral control, and ventral frontostriatal circuits, connecting to brain regions implicated in emotion processing, that control valuation and learning processes.

FINDINGS AND CONCLUSION

Based on clinical insights and considering each of the decision-making stages in turn, we outline disorder-specific hypotheses about impaired decision making in four childhood disorders: attention-deficit/hyperactivity disorder (ADHD), conduct disorder (CD), depression, and anxiety. We hypothesize that decision making in ADHD is deficient (i.e. inefficient, insufficiently reflective, and inconsistent) and impulsive (biased toward immediate over delayed alternatives). In CD, it is reckless and insensitive to negative consequences. In depression, it is disengaged, perseverative, and pessimistic, while in anxiety, it is hesitant, risk-averse, and self-deprecating. A survey of current empirical indications related to these disorder-specific hypotheses highlights the limited and fragmentary nature of the evidence base and illustrates the need for a major research initiative in decision making in childhood disorders. The final section highlights a number of important additional general themes that need to be considered in future research.

Early starting, aggressive, and/or callous-unemotional? Examining the overlap and predictive utility of antisocial behavior subtypes

Antisocial behavior (AB) in adolescence predicts problematic outcomes in adulthood. However, researchers have noted marked heterogeneity within the broad group of youth engaging in these destructive behaviors and have attempted to identify those with distinct etiologies and different trajectories of symptoms. In the present study, we evaluate 3 prominent AB subtyping approaches: age of onset, presence of callous-unemotional (CU) traits, and aggressive versus rule-breaking symptoms. We examined the overlap of these subtypes and their predictive validity in a diverse sample of 268 low-income young men followed prospectively from adolescence into emerging adulthood. We found that those with early starting AB were uniquely high on aggressive symptoms but not on CU traits. Early starting AB and both aggression and rule breaking measured during adolescence predicted most subsequent psychiatric and AB outcomes in early adulthood in univariate models, whereas CU traits were only predictive of adolescent arrests, later substance dependence diagnosis, and later CU traits. Finally, after accounting for shared variance among predictor variables, we found that aggressive symptoms explained the most unique variance in predicting several later outcomes (e.g., antisocial personality disorder) over and above other subtyping approaches. Results are discussed in relation to of the use of existing subtyping approaches to AB, noting that aggression and age of onset but not CU traits appear to be the best at predicting later negative outcome.

Emotional reactivity in referred youth with disruptive behavior disorders: the role of the callous-unemotional traits

Deficits in emotional reactivity are frequently reported in Disruptive Behavior Disorders (DBDs). A deficit in prosocial emotions, namely the callous unemotional traits (CU), may be a mediator of emotional reactivity. Our aim is to investigate subjective emotional reactivity towards visual stimuli with different affective valence in youths with DBDs and healthy controls. The clinical sample included 62 youths with DBDs (51 males, 8 to 16 years, mean 11.3±2.1 years), the control group 53 subjects (36 males, 8 to 16 years, mean 10.8±1.5 years). The groups were compared using the Child Behavior Checklist (CBCL), the Inventory of Callous-Unemotional Traits (ICU), and the International Affective Picture System (IAPS), which explores the affective (pleasant/unpleasant emotional reaction) and arousal (low/high intensity of emotion) dimensions. The DBD group presented higher scores in externalizing and internalizing CBCL scores, and in ICU callous and indifferent subscales. At the IAPS, DBD patients differed from controls in the affective valence of the images, rating less unpleasant neutral and negative images. The CU traits were the only predictor of emotional reactivity in the DBD sample. A less aversive way to interpret neutral and negative stimuli may explain why DBD patients are less responsive to negative reinforcements.

Evaluation of the known behavioral heterogeneity in conduct disorder to improve its assessment and treatment

BACKGROUND

Conduct Disorder (CD) is among the most highly represented diagnostic problems in child and adolescent mental health treatment settings. There is a great deal of heterogeneity within the CD category, with potentially important implications for case conceptualization and treatment. The current review sought to detail forms of heterogeneity within CD, including callous-unemotional traits, comorbid Attention-Deficit Hyperactivity Disorder (ADHD), aggressive and nonaggressive antisocial behavior, and age of onset.

METHODS

The current review summarizes research on etiological factors, correlates, and trajectories associated with distinguishable dimensions of CD, and considers how this heterogeneity should be incorporated into the assessment and treatment of CD.

RESULTS

Callous-unemotional traits have been associated with a more severe and persistent form of CD, as have comorbid ADHD and child-onset CD. Aggressive antisocial behavior is a stable behavioral dimension that emerges in early childhood and is associated with high levels of neuroticism. Nonaggressive antisocial behavior demonstrates specific associations with impulsivity, is most frequent during adolescence, and evidences more moderate levels of stability.

CONCLUSIONS

Conduct disorder is a highly heterogeneous disorder. Although the clinical implications of this heterogeneity are discussed, future research is clearly needed to shore up our understanding of the clinical ramifications of the sub-dimensions within CD.

Delinquenz

Jugenddelinquenz stellt ein ubiquitäres, statistisch normales Phänomen in westlichen Gesellschaften dar. Obwohl über die Entwicklung dissozialen Verhaltens viele Fakten aus Längsschnittstudien bekannt sind, fehlen aktuell erprobte und aussagekräftige Diagnoseverfahren zur frühzeitigen Identifikation massiv delinquenz- und gewaltbereiter Jugendlicher. Solche Verfahren zur Risikoabschätzung sind die Voraussetzung dafür, sekundärpräventive Maßnahmen für solche Jugendliche zu planen und zu implementieren.

Describing and predicting developmental profiles of externalizing problems from childhood to adulthood

This longitudinal study considers externalizing behavior problems from ages 5 to 27 (N = 585). Externalizing problem ratings by mothers, fathers, teachers, peers, and self-report were modeled with growth curves. Risk and protective factors across many different domains and time frames were included as predictors of the trajectories. A major contribution of the study is in demonstrating how heterotypic continuity and changing measures can be handled in modeling changes in externalizing behavior over long developmental periods. On average, externalizing problems decreased from early childhood to preadolescence, increased during adolescence, and decreased from late adolescence to adulthood. There was strong nonlinear continuity in externalizing problems over time. Family process, peer process, stress, and individual characteristics predicted externalizing problems beyond the strong continuity of externalizing problems. The model accounted for 70% of the variability in the development of externalizing problems. The model's predicted values showed moderate sensitivity and specificity in prediction of arrests, illegal drug use, and drunk driving. Overall, the study showed that by using changing, developmentally relevant measures and simultaneously taking into account numerous characteristics of children and their living situations, research can model lengthy spans of development and improve predictions of the development of later, severe externalizing problems.

Trajectories of youthful antisocial behavior: categories or continua?

The purpose of this study was to determine whether qualitatively distinct trajectories of antisocial behavior could be identified in 1,708 children (843 boys, 865 girls) from the 1979 National Longitudinal Survey of Youth-Child Data (NLSY-C). Repeated ratings were made on the Behavior Problems Index (BPI: Peterson and Zill Journal of Marriage and the Family, 48, 295-307, 1986) antisocial scale by the mothers of these children when the children were 6, 8, 10, 12, and 14 years of age. Scores on three indicators constructed from the six BPI Antisocial items (callousness, aggression, noncompliance) were then analyzed longitudinally (by summing across the rating periods) and cross-sectionally (by testing each individual rating period) in the full sample as well as in subsamples of boys and girls. Results obtained with the mean above minus below a cut (MAMBAC), maximum covariance (MAXCOV), and latent mode factor analysis (L-Mode) taxometric procedures revealed consistent evidence of continuous latent structure despite the fact Growth Mixture Modeling (GMM) and Latent Class Growth Analysis (LCGA) identified between two and eight trajectories, depending on the stopping rule, in the three antisocial indicators. From these results, it is concluded that the structural model underlying these data is better represented as continuous rather than as categorical. The implications of these results for future research on developmental trajectories of antisocial behavior are discussed.

Do etiological influences on aggression overlap with those on rule breaking? A meta-analysis

BACKGROUND

Although aggressive (AGG) and non-aggressive rule-breaking (RB) dimensions of antisocial behavior have been shown to be differentially heritable, available studies have disagreed on the extent to which the genetic and environmental factors influencing AGG also influence RB. The current meta-analysis sought to clarify the extent of etiological overlap between AGG and RB. Method Thirteen twin/sibling studies examining the covariation between AGG and RB were collected, of which 11 (with 12 independent samples) were ultimately included in the analyses (n=12923 twin/sibling pairs). Genetic and environmental correlations between AGG and RB served as study effect sizes. When squared, these correlations directly index the proportion of genetic and environmental overlap. Data were analyzed using mixed effect models.

RESULTS

Analyses revealed that genetic influences on AGG were largely, but not entirely, distinct from those on RB: only 38.4% of the genetic influences on AGG overlapped with those on RB. Similarly, only 10.2% of the non-shared environmental influences on AGG overlapped with those on RB. Although the conclusion that etiological influences on AGG are partially distinct from those on RB persisted across several potential moderators, the age of the sample and the informant used were found to moderate the extent of overlap.

CONCLUSIONS

The findings underscore the presence of meaningful etiological distinctions between AGG and RB, and imply that future conceptualizations of antisocial behavior should be organized (at least in part) around the dimensions of AGG and RB.

Research review: evaluating and reformulating the developmental taxonomic theory of antisocial behaviour

BACKGROUND

The developmental taxonomic theory proposes that there are two subtypes of antisocial behaviour. The first is a neurodevelopmental disorder which emerges in early childhood and follows a life-course persistent course, whereas the second emerges in adolescence, remits in early adulthood and reflects peer processes such as mimicry of antisocial peers. The aim of this review was to evaluate the developmental taxonomic theory in the light of recent empirical research.

METHODS

We conducted a comprehensive literature review comparing these subtypes of antisocial behaviour based on searches on PubMed and other scientific databases covering the period from 1993 to 2013. We focused on research encompassing psychiatric epidemiology, personality assessment, neuropsychology, neuroendocrinology, genetics, and structural and functional neuroimaging. Sixty one empirical studies were identified that investigated one of these forms of antisocial behaviour separately or explicitly compared childhood-onset and adolescence-onset forms of antisocial behaviour.

RESULTS

Empirical research provides support for the hypothesis that life-course persistent antisocial behaviour is a neurodevelopmental disorder which emerges in the transactions between individual vulnerabilities and environmental adversity. In contrast to the developmental taxonomic theory, however, empirical findings suggest that severe antisocial behaviour that emerges in adolescence frequently has a negative prognosis and is rarely limited to the adolescent period. In addition, both forms of antisocial behaviour are associated with emotion processing deficits, changes in brain structure and function, alterations in cortisol secretion, and atypical personality traits (such as increased callous-unemotional traits).

CONCLUSIONS

We conclude that the developmental taxonomic theory is in need of revision, as differences between life-course persistent and adolescence-onset forms of antisocial behaviour appear to be quantitative, rather than qualitative, in nature. In addition, evidence is accumulating that adolescence-onset antisocial behaviour may also be a neurodevelopmental disorder. To account for the similarities between these groups, despite the differences in their age-of-onset, we propose that the quality of the child's early environment moderates the relationship between individual vulnerabilities and the age-of-onset of antisocial behaviour.

Understanding Youth Antisocial Behavior Using Neuroscience through a Developmental Psychopathology Lens: Review, Integration, and Directions for Research

Youth antisocial behavior (AB) is an important public health concern impacting perpetrators, victims, and society. Functional neuroimaging is becoming a more common and useful modality for understanding neural correlates of youth AB. Although there has been a recent increase in neuroimaging studies of youth AB and corresponding theoretical articles on the neurobiology of AB, there has been little work critically examining the strengths and weaknesses of individual studies and using this knowledge to inform the design of future studies. Additionally, research on neuroimaging and youth AB has not been integrated within the broader framework of developmental psychopathology. Thus, this paper provides an in-depth review of the youth AB functional neuroimaging literature with the following goals: 1. to evaluate how this literature has informed our understanding of youth AB, 2. to evaluate current neuroimaging studies of youth AB from a developmental psychopathology perspective with a focus on integrating research from neuroscience and developmental psychopathology, as well as placing this research in the context of other related areas (e.g., psychopathy, molecular genetics), and 3. to examine strengths and weaknesses of neuroimaging and behavioral studies of youth AB to suggest how future studies can develop a more informed and integrated understanding of youth AB.

Effects of parenting and deviant peers on early to mid-adolescent conduct problems

We investigated the influence of effective parenting behaviors (father and mother reports) and deviant peer association (adolescent reports) on subsequent young adolescent conduct problems (teacher reports) during grades 7-9, using structural equation modeling. Data were from a sample of 226 rural adolescents (n = 112 boys; n = 107 girls; n = 7 gender unknown), their parents, and teachers. Both effective parenting and association with deviant peers influenced later conduct problems; however, the pattern of influence varied across time and between fathers and mothers, with complex patterns of interactions between effective parenting and peer deviance. From seventh to eighth grade, effective parenting by both mothers and fathers buffered the effect of higher levels of peer deviance on conduct problems across adolescent gender. From eighth to ninth grade (i.e., transition into high school), fathers' effective parenting buffered the effects of deviant peer association on their daughters' conduct problems, whereas both fathers' and mothers' influence was stronger for sons when deviant peer associations were lower. Analyses also evaluated bi-directional longitudinal effects among adolescents, parents, and peers. Although varying by parent and adolescent gender or adolescent age, results generally supported the protective effects of parenting on their children's conduct problems during early to mid adolescence.

Is relational aggression part of the externalizing spectrum? a bifactor model of youth antisocial behavior

The primary purpose of the present study was to examine support for the inclusion of relational aggression (RAgg) alongside physical aggression (Agg) and rule-breaking behaviors (RB) as a subfactor of antisocial behavior (ASB). Caregiver reports were collected for 1,087 youth (48.9% male) ages 6-18. Results indicated that all three subfactors of ASB demonstrated substantial loadings on a general ASB factor. Using a bifactor model approach, specific factors representing each ASB subfactor were simultaneously modeled, allowing for examination of common and specific correlates. At the scale level, results demonstrated consistently strong connections with high Neuroticism and low Agreeableness across all 3 ASB subfactors, a pattern which was replicated for the general ASB factor in the bifactor approach. Specific factors in the bifactor model demonstrated connections with personality and psychopathology correlates, primarily for Agg. These findings provide some support for an overall grouping of RAgg with other ASB subfactors in youth, and further distinguish Agg as potentially representing a more potent variant of youth ASB relative to both RB and RAgg.

Disentangling the role of psychopathic traits and externalizing behaviour in predicting conduct problems from childhood to adolescence

Child and youth conduct problems are known to be a heterogeneous category that implies different factors and processes. The current study aims to analyze whether the early manifestation of psychopathic traits designates a group of children with severe, pervasive and persistent conduct problems. To this end, cluster analysis was conducted in a sample of 138 children (27.6 % female), aged 6-11 at the first wave of the study (T1) and 12-17 in a follow-up carried out 6 years later (T2). Results allowed the identification of four distinctive clusters: Primarily externalizing, Externalizing-psychopathic, Primarily psychopathic and Non-problematic. As was expected, the Externalizing-psychopathic cluster showed the most severe and persistent pattern of behavioral, temperamental and social disruptions across the 6 years of the study. Early psychopathic traits seemed also to be relevant in predicting higher levels of conduct problems in T2, even when conduct disorders had not manifested in T1. These results highlight the role of psychopathic traits in predicting adolescent psychosocial disorders and the relevance to analyze them at early developmental stages.