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Michelini G, Carlisi CO, Eaton NR, Elison JT, Haltigan JD, Kotov R, Krueger RF, Latzman RD, Li JJ, Levin-Aspenson HF, Salum GA, South SC, Stanton K, Waldman ID, Wilson S. Where do neurodevelopmental conditions fit in transdiagnostic psychiatric frameworks? Incorporating a new neurodevelopmental spectrum. World Psychiatry 2024; 23:333-357. [PMID: 39279404 PMCID: PMC11403200 DOI: 10.1002/wps.21225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/18/2024] Open
Abstract
Features of autism spectrum disorder, attention-deficit/hyperactivity disorder, learning disorders, intellectual disabilities, and communication and motor disorders usually emerge early in life and are associated with atypical neurodevelopment. These "neurodevelopmental conditions" are grouped together in the DSM-5 and ICD-11 to reflect their shared characteristics. Yet, reliance on categorical diagnoses poses significant challenges in both research and clinical settings (e.g., high co-occurrence, arbitrary diagnostic boundaries, high within-disorder heterogeneity). Taking a transdiagnostic dimensional approach provides a useful alternative for addressing these limitations, accounting for shared underpinnings across neurodevelopmental conditions, and characterizing their common co-occurrence and developmental continuity with other psychiatric conditions. Neurodevelopmental features have not been adequately considered in transdiagnostic psychiatric frameworks, although this would have fundamental implications for research and clinical practices. Growing evidence from studies on the structure of neurodevelopmental and other psychiatric conditions indicates that features of neurodevelopmental conditions cluster together, delineating a "neurodevelopmental spectrum" ranging from normative to impairing profiles. Studies on shared genetic underpinnings, overlapping cognitive and neural profiles, and similar developmental course and efficacy of support/treatment strategies indicate the validity of this neurodevelopmental spectrum. Further, characterizing this spectrum alongside other psychiatric dimensions has clinical utility, as it provides a fuller view of an individual's needs and strengths, and greater prognostic utility than diagnostic categories. Based on this compelling body of evidence, we argue that incorporating a new neurodevelopmental spectrum into transdiagnostic frameworks has considerable potential for transforming our understanding, classification, assessment, and clinical practices around neurodevelopmental and other psychiatric conditions.
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Affiliation(s)
- Giorgia Michelini
- Department of Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Christina O Carlisi
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Nicholas R Eaton
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Jed T Elison
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
| | - John D Haltigan
- Department of Psychiatry, Division of Child and Youth Mental Health, University of Toronto, Toronto, ON, Canada
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Robert F Krueger
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | | | - James J Li
- Department of Psychology, University of Wisconsin-Madison, Madison, WI, USA
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Giovanni A Salum
- Child Mind Institute, New York, NY, USA
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Instituto Nacional de Psiquiatria do Desenvolvimento para a Infância e Adolescência, São Paulo, Brazil
| | - Susan C South
- Department of Psychological Sciences, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
| | - Kasey Stanton
- Department of Psychology, University of Wyoming, Laramie, WY, USA
| | - Irwin D Waldman
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Sylia Wilson
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
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Low A, Stiltner B, Nunez YZ, Adhikari K, Deak JD, Pietrzak RH, Kranzler HR, Gelernter J, Polimanti R. Association patterns of antisocial personality disorder across substance use disorders. Transl Psychiatry 2024; 14:346. [PMID: 39198385 PMCID: PMC11358160 DOI: 10.1038/s41398-024-03054-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 08/19/2024] [Accepted: 08/21/2024] [Indexed: 09/01/2024] Open
Abstract
There is a high prevalence of antisocial personality disorder (ASPD) in individuals affected by substance use disorders (SUD). However, there is limited information on the specific patterns of association of ASPD with SUD severity and specific SUD diagnostic criteria. We investigated the association of alcohol, cannabis, cocaine, opioid, and tobacco use disorders (AUD, CanUD, CocUD, OUD, and TUD, respectively) in 1660 individuals with ASPD and 6640 controls matched by sex (24% female), age, and racial/ethnic background in a sample ascertained for addiction-related traits. Generalized linear regressions were used to test ASPD with respect to the five DSM-5 SUD diagnoses, their severity (i.e., mild, moderate, severe), and their diagnostic criteria. We found that ASPD is associated with the diagnosis and severity of AUD (Odds Ratio, ORs = 1.89 and 1.25), CanUD (ORs = 2.13 and 1.32), and TUD (ORs = 1.50 and 1.21) (ps < 0.003). Of the specific diagnostic criteria, the "hazardous use" criterion showed the strongest association with ASPD across the five SUDs investigated (from ORTUD = 1.88 to ORCanUD = 1.37). However, when criteria of different SUDs were included in the same model, ASPD was independently associated only with TUD "hazardous use" and CocUD "attempts to quit". Attempting to quit cocaine was inversely related to the presence of ASPD and remained significant (OR = 0.57, 95% confidence interval = 0.36-0.89) after controlling for interactive effects with sex. The current work provides novel insights into ASPD-SUD comorbidity, supporting the existence of different SUD patterns among individuals affected by ASPD.
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Affiliation(s)
- Aislinn Low
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Brendan Stiltner
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Yaira Z Nunez
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Keyrun Adhikari
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Joseph D Deak
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Henry R Kranzler
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Mental Illness Research, Education, and Clinical Center, Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Joel Gelernter
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
- Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - Renato Polimanti
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
- VA Connecticut Healthcare System, West Haven, CT, USA.
- Wu Tsai Institute, Yale University, New Haven, CT, USA.
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Greń J, Richards DK, Pearson MR, Ostaszewski K. Development and validation of the Substance Use Protective Strategies Scale (SUPSS) among Polish young adults using various psychoactive substances. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023:104216. [PMID: 37802721 DOI: 10.1016/j.drugpo.2023.104216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/19/2023] [Accepted: 09/23/2023] [Indexed: 10/08/2023]
Abstract
Research supports protective behavioral strategies (PBS) as effective in reducing substance use, intoxication, and/or related risks/harms. However, despite the predominance of polysubstance use and common co-occurrence of different substance use disorders (SUDs), previous PBS research has been limited in terms of substance-specific measurement. This study sought to develop and validate a measure of PBS that is not substance-specific. Building from initial pilot work, we tested the psychometric properties of the Substance Use Protective Strategies Scale (SUPSS) in a large sample of young adults (N = 7325, aged 18-30), who reported using multiple psychoactive substances (other than alcohol and nicotine), recruited via social media in Poland. By splitting the sample, we conducted exploratory (n = 3709) and confirmatory factor analysis (n = 3614), which supported a 4-factor structure with 19 items (7 items dropped): Preparation for use (α = 0.66), Manner of use (α = 0.85), Additional concerns (α = 0.74), and Setting (α = 0.62). Configural, metric and scalar invariance were supported across sex, age, and user status for most substance types (cannabis, dissociatives, etc.). Further, the SUPSS factors were strongly associated with substance-related harms (R-squared = 0.495) and SUD symptoms (DUDIT, R-squared = 0.570). Our model fit was adequate (but not excellent), and two subscales had low internal consistency, highlighting the need for further improvement of the SUPSS. Despite its limitations, we found the SUPSS to have strong psychometric properties and it holds promise to enhance PBS research and harm reduction-oriented interventions.
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Affiliation(s)
- Jakub Greń
- Public Health Department, Institute of Psychiatry and Neurology in Warsaw, Poland; Center of Alcohol, Substance use, And Addictions (CASAA), University of New Mexico, USA.
| | - Dylan K Richards
- Center of Alcohol, Substance use, And Addictions (CASAA), University of New Mexico, USA
| | - Matthew R Pearson
- Center of Alcohol, Substance use, And Addictions (CASAA), University of New Mexico, USA
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Low A, Stiltner B, Nunez YZ, Adhikari K, Deak JD, Pietrzak RH, Kranzler HR, Gelernter J, Polimanti R. Association Patterns of Antisocial Personality Disorder across Substance Use Disorders. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.15.23295625. [PMID: 37745497 PMCID: PMC10516074 DOI: 10.1101/2023.09.15.23295625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
There is a high prevalence of antisocial personality disorder (ASPD) in individuals affected by substance use disorders (SUD). However, there is limited information on the specific patterns of association of ASPD with SUD severity and specific SUD diagnostic criteria. We investigated the association of alcohol, cannabis, cocaine, opioid, and tobacco use disorders (AUD, CanUD, CocUD, OUD, and TUD, respectively) in 1,660 individuals with ASPD and 6,640 controls matched by sex (24% female), age, and racial/ethnic background in a sample ascertained for addiction-related traits. Generalized linear regressions were used to test the association of ASPD with the five DSM-5 SUD diagnoses, their severity (i.e., mild, moderate, severe), and their individual diagnostic criteria. We found that ASPD is associated with the diagnosis and severity of AUD (Odds Ratio, ORs=1.89 and 1.25), CanUD (ORs=2.13 and 1.32), and TUD (ORs=1.50 and 1.21) ( ps <.003). Of the specific diagnostic criteria, the "hazardous use" criterion showed the strongest association with ASPD across the five SUDs investigated (from OR TUD =1.88 to OR CanUD =1.37). However, when criteria of different SUDs were included in the same model, ASPD was independently associated only with TUD "hazardous use" and CocUD "attempts to quit". Attempting to quit cocaine was inversely related to the presence of ASPD and remained significant (OR=0.57, 95% confidence interval = 0.36-0.89) after controlling for interactive effects with sex. The current work provides novel insights into how different SUDs, their severity, and their diagnostic criteria associate with ASPD, potentially furthering our understanding of the impact of polysubstance addiction on mental health.
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Chan L, Simmons C, Tillem S, Conley M, Brazil IA, Baskin-Sommers A. Classifying Conduct Disorder Using a Biopsychosocial Model and Machine Learning Method. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:599-608. [PMID: 35217219 PMCID: PMC9393206 DOI: 10.1016/j.bpsc.2022.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/10/2022] [Accepted: 02/08/2022] [Indexed: 05/11/2023]
Abstract
BACKGROUND Conduct disorder (CD) is a common syndrome with far-reaching effects. Risk factors for the development of CD span social, psychological, and biological domains. Researchers note that predictive models of CD are limited if the focus is on a single risk factor or even a single domain. Machine learning methods are optimized for the extraction of trends across multidomain data but have yet to be implemented in predicting the development of CD. METHODS Social (e.g., family, income), psychological (e.g., psychiatric, neuropsychological), and biological (e.g., resting-state graph metrics) risk factors were measured using data from the baseline visit of the Adolescent Brain Cognitive Development Study when youth were 9 to 10 years old (N = 2368). Applying a feed-forward neural network machine learning method, risk factors were used to predict CD diagnoses 2 years later. RESULTS A model with factors that included social, psychological, and biological domains outperformed models representing factors within any single domain, predicting the presence of a CD diagnosis with 91.18% accuracy. Within each domain, certain factors stood out in terms of their relationship to CD (social: lower parental monitoring, more aggression in the household, lower income; psychological: greater attention-deficit/hyperactivity disorder and oppositional defiant disorder symptoms, worse crystallized cognition and card sorting performance; biological: disruptions in the topology of subcortical and frontoparietal networks). CONCLUSIONS The development of an accurate, sensitive, and specific predictive model of CD has the potential to aid in prevention and intervention efforts. Key risk factors for CD appear best characterized as reflecting unpredictable, impulsive, deprived, and emotional external and internal contexts.
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Affiliation(s)
- Lena Chan
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Cortney Simmons
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Scott Tillem
- Department of Psychology, University of Michigan Ann Arbor, Ann Arbor, Michigan
| | - May Conley
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Inti A Brazil
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands; Forensic Psychiatric Centre Pompestichting, Nijmegen, the Netherlands
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Langwerden RJ, Van der Heijden PT, Claassen T, Derksen JJL, Egger JIM. The structure of dimensions of psychopathology in normative and clinical samples: Applying causal discovery to MMPI-2-RF scales to investigate clustering of psychopathology spectra and p-factors. Front Psychiatry 2022; 13:1026900. [PMID: 36440421 PMCID: PMC9686405 DOI: 10.3389/fpsyt.2022.1026900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022] Open
Abstract
We applied a Bayesian Constraint-based Causal Discovery method (BCCD) to examine the hierarchical structure of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) Restructured Clinical (RC) scales. Two different general psychopathology super spectra (p-factor) scales were extracted from (1) all RC scales and (2) all RC scales except the RCd (Demoralization) scale. These p-factor scales were included in separate models to investigate the structure of dimensions of psychopathology in a normative (n = 3,242) and clinical (n = 2,466) sample, as well as the combined normative/clinical sample (N = 5,708), by applying the BCCD algorithm to obtain a data-driven reconstruction of the internal hierarchical structure of the MMPI-2-RF. Research on the underlying structure of the MMPI-2-RF has clinical relevance as well as conceptual relevance in the context of the HiTOP model. Results demonstrated that the syndromes measured with the RC-scales-in presence of a p-factor-cluster into six spectra: internalizing, disinhibited-externalizing, antagonistic-externalizing, thought disorder, detachment, and somatoform. These results may support a super spectrum construct, as it was necessary for obtaining a bottom-up reconstruction of this six-spectrum structure. We found support for superiority of a broad super spectrum with additional variance over and above demoralization, as it resulted in the clearest structure (i.e., clustering of the RC scales). Furthermore, our results indicate independent support for the bifactor structure model of psychopathology.
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Affiliation(s)
- Robbert J Langwerden
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, Netherlands.,Community-Based Research Institute, Florida International University, Miami, FL, United States
| | - Paul T Van der Heijden
- Behavioral Science Institute, Radboud University Nijmegen, Nijmegen, Netherlands.,Centre for Adolescent Psychiatry, Reinier van Arkel Mental Health Institute, 's-Hertogenbosch, Netherlands
| | - Tom Claassen
- Institute for Computing and Information Sciences, Faculty of Science, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Jan J L Derksen
- Behavioral Science Institute, Radboud University Nijmegen, Nijmegen, Netherlands.,Faculty of Psychology and Educational Sciences, Department of Clinical and Life Span Psychology, Vrije Universiteit Brussels, Brussels, Belgium
| | - Jos I M Egger
- Centers of Excellence in Neuropsychiatry, Vincent van Gogh Mental Health Institute, Venray, Netherlands.,Stevig Specialized and Forensic Care for People With Intellectual Disabilities, Oostrom, Netherlands
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7
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Deutsch AR. Punch-Drunk or Drunken Boxing? The Etiology of Alcohol-Related Physical Violence through Adolescence and Young Adulthood. Subst Use Misuse 2021; 56:615-626. [PMID: 33691595 PMCID: PMC9275523 DOI: 10.1080/10826084.2021.1887244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Alcohol-related physical violence (ARPV) can be a causal consequence of alcohol consumption, but only for specific individuals (e.g., those predisposed to violence). Studies have not accounted for the shared etiology explaining comorbidity between alcohol use and violent behavior as a potential third-variable explanation of ARPV. The current study examined genetically-informed associations between ARPV, heavy alcohol use (HAU) and overall physical violence (OPV) in adolescence and young adulthood, by testing two proposed theories of ARPV processes (HAU causes ARPV, causal relationships depend upon OPV) and how overarching shared covariance may account for these associations. METHODS Using the twin and sibling subsample from the National Longitudinal Study of Adolescent to Adult Health (Add Health), a series of biometric models tested hypotheses individually in adolescence and young adulthood. This included estimating bivariate Cholesky and direction-of-causality models, and trivariate Cholesky, independent pathway, and common pathway models. RESULTS HAU had a causal effect on ARPV in adolescence and young adulthood. This effect was not moderated by OPV at either developmental stage. A shared etiology or common latent factor did not explain associations between ARPV, OPV, and HAU, even though ARPV strongly covaried independently with HAU and with OPV. Finally, OPV also had a causal effect on ARPV in adolescence, and in young adulthood for adolescent-onset drinkers. CONCLUSIONS Causal theories of ARPV still hold when accounting for shared genetic and environmental variance. Further research on the exact role of violence (predispositions, environmental contexts) is required, as both phenotypes substantially (and separately) explain influences driving ARPV. UNLABELLED Supplemental data for this article is available online at https://doi.org/10.1080/10826084.2021.1887244.
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Affiliation(s)
- Arielle R Deutsch
- Avera Health, Avera Research Institute, Sioux Falls, SD, USA.,Sanford School of Medicine, Pediatrics, University of South Dakota, Vermillion, SD, USA
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Smith ZR, Zald DH, Lahey BB. Sluggish Cognitive Tempo and Depressive Symptoms in Children and Adolescents Predict Adulthood Psychopathology. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 48:1591-1601. [PMID: 32918187 PMCID: PMC10704703 DOI: 10.1007/s10802-020-00692-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Sluggish cognitive tempo (SCT) is characterized by behavioral symptoms reflecting slowness and lethargy (e.g., sluggishness, appearing sleepy) and inconsistent alertness/mental confusion (e.g., daydreaming, fogginess). SCT is substantially correlated with the inattentive symptoms of attention-deficit/hyperactivity disorder (ADHD) and may be part of that domain, but in cross-sectional data, SCT is also strongly associated with both inattention and depression. To date, no study has examined the prospective associations of SCT symptoms in childhood/adolescence with symptoms of ADHD and internalizing problems in adulthood. Using a sample of 449 twin children and adolescent pairs, prospective multiple regression analyses examined whether self- and parent-reported SCT, depression, and parent-reported symptoms of ADHD predicted symptoms in adulthood 12 years later. SCT and depression at time one were strongly correlated (self-reported SCT and depression r = 0.84; parent-reported SCT and depression r = 0.78). When adult outcomes were separately regressed on each youth symptom dimension, self-reported SCT (β = 0.26, p < 0.0001) and depression (β = 0.13, p < 0.0001) each predicted adult symptoms of depression and self-reported SCT predicted inattention (β = 0.12, p = 0.0026). Parent-reported depression, but not parent-reported SCT, predicted self-reported adult depression symptoms (β = 0.17, p = 0.0003). In contrast, when each adult outcome was regressed simultaneously on youth self-reported SCT and depression, neither predicted adulthood inattention or depression. These findings indicate that SCT in childhood and adolescence is strongly associated concurrently and predictively with both inattention and depression. Theoretical and clinical applications of the construct of SCT must take its robust association with both inattention and depression into account.
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Bailey AJ, Finn PR. Borderline Personality Disorder Symptom Comorbidity Within a High Externalizing Sample: Relationship to the Internalizing-Externalizing Dimensional Structure of Psychopathology. J Pers Disord 2020; 34:814-826. [PMID: 30730780 PMCID: PMC7282285 DOI: 10.1521/pedi_2019_33_415] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Borderline personality disorder (BPD) is highly comorbid with internalizing and externalizing psychopathology. The current study replicates findings indicating that BPD symptomatology is influenced by the distress subfactor of both the internalizing and the externalizing dimension of psychopathology. Confirmatory factor analysis of the covariance of continuous measures of externalizing pathology, internalizing pathology, and BPD symptoms was assessed in 837 young adults. The sample contained a range of externalizing severity from none to high severity, leading to an overrepresentation of externalizing problems. BPD symptoms were associated with both the externalizing dimension and the distress subfactor of the internalizing dimension. Interestingly, BPD had a stronger association with the externalizing dimension than observed in previous studies. Results replicated earlier findings using different and more dimensional measures. Findings indicated that BPD is more heavily influenced by the externalizing dimension of psychopathology within a high externalizing sample, such as those presenting for treatment of alcohol or substance use disorders.
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Affiliation(s)
- Allen J Bailey
- Department of Psychological and Brain Sciences, Indiana University-Bloomington
| | - Peter R Finn
- Department of Psychological and Brain Sciences, Indiana University-Bloomington
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10
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Bailey AJ, Finn PR. Examining the Utility of a General Substance Use Spectrum Using Latent Trait Modeling. Drug Alcohol Depend 2020; 212:107998. [PMID: 32362437 PMCID: PMC7293921 DOI: 10.1016/j.drugalcdep.2020.107998] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Polysubstance use (PSU; lifetime use of multiple substances) is common among individuals with problematic alcohol/substance use and is associated with poor prognosis and poor physical/mental health. Furthermore, simultaneous co-use of substances, such that drug effects overlap, is also common and related to unique risks (e.g. overdose). Despite the importance of PSU, current diagnostic systems continue to conceptualize problems with alcohol/substances as class-specific constructs (e.g. Stimulant Use Disorder), which essentially ignore many unique PSU processes. METHODS The current study modeled problems with alcohol, cannabis, stimulants, sedatives, opiates, and simultaneous co-use of these substances as a manifestation of a general substance use continuum versus as correlated class-specific constructs in a sample of young-adults(n = 2482) using confirmatory factor analysis. Utility of the models was evaluated by examining associations between the general substance use spectrum and class-specific latent factors with measures of anxiety, ADHD, adult antisocial problems, borderline symptoms, neuroticism, and intelligence in a subset of the sample(n=847). RESULTS Findings supported the conceptualization of problems with all substances, including co-use of substances, as being manifestations of a general substance use spectrum, as class-specific constructs were not differentially associated with other measures of psychological dysfunction. Examination of this general substance use spectrum indicated that all substances, separately and co-use, were robustly informative of this spectrum, but tended to discriminate between different severity levels. DISCUSSION The general substance use spectrum allows for integration of information from the use and co-use of all substances to provide better assessment of overall problems with substances compared to class-specific constructs.
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Affiliation(s)
- Allen J Bailey
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, USA; Department of Psychological and Brain Sciences, Indiana University, 1101 East 10th Street, Bloomington, IN, 47405, USA.
| | - Peter R Finn
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, USA; Department of Psychological and Brain Sciences, Indiana University, 1101 East 10th Street, Bloomington, IN, 47405, USA.
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11
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Lahey BB, Hinton KE, Meyer FC, Villalta-Gil V, Van Hulle CA, Applegate B, Yang X, Zald DH. Sex differences in associations of socioemotional dispositions measured in childhood and adolescence with brain white matter microstructure 12 years later. PERSONALITY NEUROSCIENCE 2020; 3:e5. [PMID: 32524066 PMCID: PMC7253690 DOI: 10.1017/pen.2020.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 11/22/2019] [Accepted: 02/09/2020] [Indexed: 01/10/2023]
Abstract
Predictive associations were estimated between socioemotional dispositions measured at 10-17 years using the Child and Adolescent Dispositions Scale (CADS) and future individual differences in white matter microstructure measured at 22-31 years of age. Participants were 410 twins (48.3% monozygotic) selected for later neuroimaging by oversampling on risk for psychopathology from a representative sample of child and adolescent twins. Controlling for demographic covariates and total intracranial volume (TICV), each CADS disposition (negative emotionality, prosociality, and daring) rated by one of the informants (parent or youth) significantly predicted global fractional anisotropy (FA) averaged across the major white matter tracts in brain in adulthood, but did so through significant interactions with sex after false discovery rate (FDR) correction. In females, each 1 SD difference in greater parent-rated prosociality was associated with 0.43 SD greater FA (p < 0.0008). In males, each 1 SD difference in greater parent-rated daring was associated with 0.24 SD lower FA (p < 0.0008), and each 1 SD difference in greater youth-rated negative emotionality was associated with 0.18 SD greater average FA (p < 0.0040). These findings suggest that CADS dispositions are associated with FA, but associations differ by sex. Exploratory analyses suggest that FA may mediate the associations between dispositions and psychopathology in some cases. These associations over 12 years could reflect enduring brain-behavior associations in spite of transactions with the environment, but could equally reflect processes in which dispositional differences in behavior influence the development of white matter. Future longitudinal studies are needed to resolve the causal nature of these sex-moderated associations.
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Affiliation(s)
- Benjamin B. Lahey
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Kendra E. Hinton
- Department of Psychological Sciences, Vanderbilt University, Nashville, TN, USA
| | | | | | - Carol A. Van Hulle
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Brooks Applegate
- Department of Educational Leadership, Research, and Technology, Western Michigan University, Kalamazoo, MI, USA
| | - Xiaochan Yang
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - David H. Zald
- Department of Psychological Sciences, Vanderbilt University, Nashville, TN, USA
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Testing alternative cascades from internalizing and externalizing symptoms to adolescent alcohol use and alcohol use disorder through co-occurring symptoms and peer delinquency. Dev Psychopathol 2020; 33:29-46. [PMID: 32308172 DOI: 10.1017/s0954579419001512] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Given the equivocal literature on the relationship between internalizing symptoms and early adolescent alcohol use (AU) and AU disorder (AUD), the present study took a developmental perspective to understand how internalizing and externalizing symptoms may operate together in the etiology of AU and AUD. We pit the delayed onset and rapid escalation hypothesis (Hussong et al., 2011) against a synthesis of the dual failure model and the stable co-occurring hypothesis (Capaldi, 1992; Colder et al., 2013, 2018) to test competing developmental pathways to adolescent AU and AUD involving problem behavior, peer delinquency, and early initiation of AU. A latent transactional and mediational framework was used to test pathways to AUD spanning developmental periods before AU initiation (Mage = 11) to early and high risk for AUD (Mage = 14-15 and Mage = 17-18). The results supported three pathways to AUD. The first started with "pure" externalizing symptoms in early childhood and involved multiple mediators, including the subsequent development of co-occurring symptoms and peer delinquency. The second pathway involved stable co-occurring symptoms. Interestingly, chronically elevated pure internalizing symptoms did not figure prominently in pathways to AUD. Selection and socialization effects between early AU and peer delinquency constituted a third pathway.
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Chamberlain SR, Stochl J, Grant JE. Longitudinal subtypes of disordered gambling in young adults identified using mixed modeling. Prog Neuropsychopharmacol Biol Psychiatry 2020; 97:109799. [PMID: 31676469 PMCID: PMC6837885 DOI: 10.1016/j.pnpbp.2019.109799] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/22/2019] [Accepted: 10/28/2019] [Indexed: 12/05/2022]
Abstract
OBJECTIVE While many individuals gamble responsibly, some develop maladaptive symptoms of a gambling disorder. Gambling problems often first occur in young people, yet little is known about the longitudinal course of such symptoms and whether this course can be predicted. The aim of this study was to identify latent subtypes of disordered gambling based on symptom presentation and identify predictors of persisting gambling symptoms over time. METHODS 575 non-treatment seeking young adults (mean age [SD] = 22.3 [3.6] years; 376 (65.4%) male) were assessed at baseline and annually, over three years, using measures of gambling severity. Latent subtypes of gambling symptoms were identified using latent mixture modeling. Baseline differences were characterized using analysis of variance and binary logistic regression respectively. RESULTS Three longitudinal phenotypes of disordered gambling were identified: high harm group (N = 5.6%) who had moderate-severe gambling disorder at baseline and remained symptomatic at follow-up; intermediate harm group (19.5%) who had problem gambling reducing over time; and low harm group (75.0%) who were essentially asymptomatic. Compared to the low harm group, the other two groups had worse baseline quality of life, elevated occurrence of other mental disorders and substance use, higher body mass indices, and higher impulsivity, compulsivity, and cognitive deficits. Approximately 5% of the total sample showed worsening of gambling symptoms over time, and this rate did not differ significantly between the groups. CONCLUSIONS Three subtypes of disordered gambling were found, based on longitudinal symptom data. Even the intermediate gambling group had a profundity of psychopathological and untoward physical health associations. Our data indicate the need for large-scale international collaborations to identify predictors of clinical worsening in people who gamble, across the full range of baseline symptom severity from minimal to full endorsement of current diagnostic criteria for gambling disorder.
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Affiliation(s)
- Samuel R Chamberlain
- Department of Psychiatry, University of Cambridge, UK; Cambridge and Peterborough NHS Foundation Trust, UK
| | - Jan Stochl
- Department of Psychiatry, University of Cambridge, UK; Department of Kinanthropology, Charles University in Prague, Czechia; Cambridge and Peterborough NHS Foundation Trust, UK.
| | - Jon E Grant
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, United States of America.
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Holla B, Bharath RD, Venkatasubramanian G, Benegal V. Altered brain cortical maturation is found in adolescents with a family history of alcoholism. Addict Biol 2019; 24:835-845. [PMID: 30058761 DOI: 10.1111/adb.12662] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 05/31/2018] [Accepted: 06/25/2018] [Indexed: 12/21/2022]
Abstract
Substance-naïve offspring from high-density alcohol use disorder (AUD) families exhibit altered subcortical brain volumes structurally and altered executive-functioning and emotion-processing functionally, compared with their peers. However, there is a dearth of literature exploring alterations of cortical thickness (CTh) in this population. T1-weighted structural brain MRI was acquired in 75 substance-naïve male offspring of treatment-seeking early onset (<25 years) AUD patients with high familial loading of AUDs (≥2 affected relatives) (FHP) and 65 age-matched substance-naïve male controls with negative family history from the community. Surface-based CTh reconstruction was done using FreeSurfer. Univariate general linear models were implemented at each vertex using SurfStat, controlling for age (linear and quadratic effects), and head size, to examine the main effect of familial AUD risk on CTh and its relationship with externalizing symptom score (ESS). A Johnson-Neyman procedure revealed that the main effect of familial AUD risk on CTh was seen during adolescence, where the FHP group had thicker cortices involving bilateral precentral gyri, left caudal middle frontal gyrus (MFG), bilateral temporo-parietal junction, left inferior-frontal gyrus and right inferior-temporal gyrus. Thicker cortices in left MFG and inferior-parietal lobule were also associated with greater ESS within both groups. More importantly, these group differences diminished with age by young adulthood. Familial AUD risk is associated with age-related differences in maturation of several higher order association cortices that are critical to ongoing development in executive function, emotion regulation and social cognition during adolescence. Early supportive intervention for a delay in alcohol initiation during this critical phase may be crucial for this at-risk population.
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Affiliation(s)
- Bharath Holla
- Centre for Addiction Medicine, Department of PsychiatryNational Institute of Mental Health and Neurosciences (NIMHANS) India
| | - Rose Dawn Bharath
- Cognitive Neuroscience Centre and Department of Neuroimaging and Interventional RadiologyNIMHANS India
| | | | - Vivek Benegal
- Centre for Addiction Medicine, Department of PsychiatryNational Institute of Mental Health and Neurosciences (NIMHANS) India
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15
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Class QA, Van Hulle CA, Rathouz PJ, Applegate B, Zald DH, Lahey BB. Socioemotional dispositions of children and adolescents predict general and specific second-order factors of psychopathology in early adulthood: A 12-year prospective study. JOURNAL OF ABNORMAL PSYCHOLOGY 2019; 128:574-584. [PMID: 31259570 DOI: 10.1037/abn0000433] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We previously hypothesized that the ubiquitous, but patterned correlations among all dimensions of psychopathology reflect a hierarchy of progressively more nonspecific causal influences, with a general factor of psychopathology-also dubbed the p factor-reflecting the most transdiagnostic causal influences. We further hypothesized that the general factor is a manifestation of individual differences in 1 or more trait-like dispositions, particularly negative emotionality, that are nonspecifically associated with risk for essentially every dimension of psychopathology. We tested the hypothesis that this and other dispositions measured in childhood/adolescence significantly predict general and specific second-order dimensions of psychopathology in early adulthood. The latent general factor of psychopathology itself was correlated over time from 10-17 to 23-31 years of age even though it was defined by different informants and different dimensions of symptoms. Using a measure of dispositions that minimizes item contamination with psychopathology symptoms, parent-rated negative emotionality in childhood and adolescence predicted the general factor of psychopathology based on self-reported symptoms in early adulthood, whereas parent-rated daring predicted the specific adult externalizing psychopathology factor after correction for multiple tests. In addition, youth-rated negative emotionality and daring predicted specific adult externalizing psychopathology. These results over a span of 12 years suggests that the general factor is relatively stable over time and that associations of dispositional traits with second-order dimensions of psychopathology are enduring, sometimes across informants. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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McDowell YE, Vergés A, Sher KJ. Are Some Alcohol Use Disorder Criteria More (or Less) Externalizing than Others? Distinguishing Alcohol Use Symptomatology from General Externalizing Psychopathology. Alcohol Clin Exp Res 2019; 43:483-496. [PMID: 30620411 PMCID: PMC6397083 DOI: 10.1111/acer.13952] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 01/02/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND The externalizing spectrum contains a range of disinhibition-related conditions, such as conduct disorder, antisocial personality disorder, and substance use disorders. Comorbidity among externalizing disorders is commonly investigated at the syndromal and trait level precluding insight into the relationship of symptoms across externalizing disorders. It is unknown whether comorbidity across externalizing disorders holds constant across highly varied, individual alcohol use disorder (AUD) criteria. AUD criteria range from symptoms reflecting neuroadaptation (e.g., tolerance) to symptoms reflecting behavioral problems (e.g., social problems). The present study aimed to determine the degree to which individual AUD criteria are associated with symptomatology from other externalizing disorders. Characterization of the degree to which AUD criteria reflect neuroadaptation versus behavioral problems can be used to identify symptom profiles, which, in turn, can be used to inform diagnostic and treatment approaches. METHODS Data from 2 large nationally representative samples were used to examine associations between AUD criteria and externalizing behavior. Psychometric inquiries via multivariate and factor analytic approaches estimated relative associations of externalizing behavior and AUD criteria endorsement, as compared to alcohol consumption. RESULTS Our results indicate differential relations of externalizing behavior and AUD criteria endorsement. For example, social problems and role interference criteria were most strongly associated with externalizing behavior across analytic approaches, with general and unique associations with externalizing behavior. Additionally, tolerance was most weakly associated with externalizing behavior across approaches. CONCLUSIONS Results highlight potential etiological heterogeneity among AUD criteria that could guide future diagnostic refinements and aid in the identification of treatment targets.
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Affiliation(s)
- Yoanna E McDowell
- Department of Psychological Sciences , University of Missouri, Columbia, Missouri
| | - Alvaro Vergés
- Escuela de Psicología , Pontificia, Universidad Católica de Chile, Santiago, Región Metropolitana, Chile
| | - Kenneth J Sher
- Department of Psychological Sciences , University of Missouri, Columbia, Missouri
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Bachler E, Frühmann A, Bachler H, Aas B, Nickel M, Schiepek GK. The Effect of Childhood Adversities and Protective Factors on the Development of Child-Psychiatric Disorders and Their Treatment. Front Psychol 2018; 9:2226. [PMID: 30524336 PMCID: PMC6262315 DOI: 10.3389/fpsyg.2018.02226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/26/2018] [Indexed: 11/30/2022] Open
Abstract
Context: Families with high rates of childhood adversities (CAs) (multi problem families, MPF) have an increasing importance in public health-policy. Objective: The present study addresses the relationship between risk- and protective factors and the severity and treatment-outcome of mental disorders. Setting: Family-therapeutic home-based treatment for MPF. We examined a clinical sample (N = 1031) of children between the age of 4 to 17, and a non-clinical sample of 148 children. We hypothesized that of all children of the clinical group have a predominance of risk factors and a higher number of psychopathological symptoms. Furthermore, we hypothesized that children with a predominance of protective factors benefit stronger from psychotherapy. Main Results: In the clinical sample, most children met the criteria of a psychopathological diagnosis (95.7%, as compared to 21.6% in the non-clinical sample) and showed significant higher rates of CAs and significant less protective factors as compared to the non-clinical sample. The clinical group showed a significant reduction of psychopathological symptoms and benefited equally well from treatment. The number of risk factors was a significant predictor for a child from the non-clinical sample to meet the criteria of a psychopathological diagnosis, while the number of protective factors significantly predicted the absence thereof. Conclusion: Children and adolescents with high scores of CAs show significant associations with child psychiatric symptoms (d = 0.35; including all ICD-diagnosis such as, e.g., Asperger Syndrome, ADHD etc. with a higher rate of genetic etiology). Early life stressors, however, do not trigger an irreversible fate, as psychotherapy with young people with high numbers of risk factors does help to reduce psychopathological symptoms significantly (range of five outcome parameters: d = 0.31-0.72).
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Affiliation(s)
- Egon Bachler
- Institute for Synergetics and Psychotherapy Research, Paracelsus Medizinische Privatuniversität, Salzburg, Austria
| | | | - Herbert Bachler
- General Medicine, Innsbruck Medical University, Innsbruck, Austria
| | - Benjamin Aas
- Institute for Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Marius Nickel
- Department of Psychiatry, Medical University of Graz, Graz, Austria
| | - Guenter Karl Schiepek
- Institute for Synergetics and Psychotherapy Research, Paracelsus Medizinische Privatuniversität, Salzburg, Austria
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Schnatschmidt M, Schlarb A. Review: Schlafprobleme und psychische Störungen im Kindes- und Jugendalter. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2018; 46:368-381. [DOI: 10.1024/1422-4917/a000605] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Schlafprobleme und -störungen sind in Kindheit und Jugendalter weitverbreitet. Dieser Review beleuchtet den Zusammenhang zwischen Schlafproblemen und psychischen Störungen im Kindes- und Jugendalter. Schlafprobleme und -störungen gelten zum einen als Risikofaktoren für die Entwicklung psychischer Störungen, aber auch als Symptom und Auswirkung psychischer Störungen. Oft stehen Schlafverhalten und Psychopathologie in einer Wechselwirkung, sodass Schlafprobleme zur Intensität und Aufrechterhaltung psychischer Störungen beitragen. Dieser bidirektionale Zusammenhang ist sowohl in der frühen Kindheit als auch im Schulalter und bei Jugendlichen zu beobachten. Viele Studien konnten zeigen, dass es einen langfristigen Zusammenhang über die kindliche Entwicklung hinweg gibt. Sowohl Umweltfaktoren als auch genetische Faktoren scheinen bei der Entwicklung und Aufrechterhaltung dieses Zusammenhangs eine Rolle zu spielen. Diverse Forschungsergebnisse zeigen, dass die Behandlung von psychischen Störungen und die Behandlung von Schlafproblemen sich wechselseitig positiv beeinflussen. Daher ist die Berücksichtigung von Schlafproblemen in der Diagnostik und Behandlung, aber auch in der Prävention von psychischen Störungen dringend anzuraten.
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Affiliation(s)
- Marisa Schnatschmidt
- Fakultät für Psychologie und Sportwissenschaft, Abteilung für Psychologie, Universität Bielefeld
| | - Angelika Schlarb
- Fakultät für Psychologie und Sportwissenschaft, Abteilung für Psychologie, Universität Bielefeld
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19
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Lahey BB, Class QA, Zald DH, Rathouz PJ, Applegate B, Waldman ID. Prospective test of the developmental propensity model of antisocial behavior: from childhood and adolescence into early adulthood. J Child Psychol Psychiatry 2018; 59:676-683. [PMID: 29197109 PMCID: PMC5975120 DOI: 10.1111/jcpp.12852] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The developmental propensity model of antisocial behavior posits that several dispositional characteristics of children transact with the environment to influence the likelihood of learning antisocial behavior across development. Specifically, greater dispositional negative emotionality, greater daring, and lower prosociality-operationally, the inverse of callousness- and lower cognitive abilities are each predicted to increase risk for developing antisocial behavior. METHODS Prospective tests of key predictions derived from the model were conducted in a high-risk sample of 499 twins who were assessed on dispositions at 10-17 years of age and assessed for antisocial personality disorder (APD) symptoms at 22-31 years of age. Predictions were tested separately for parent and youth informants on the dispositions using multiple regressions that adjusted for oversampling, nonresponse, and clustering within twin pairs, controlling demographic factors and time since the first assessment. RESULTS Consistent with predictions, greater numbers of APD symptoms in adulthood were independently predicted over a 10-15 year span by higher youth ratings on negative emotionality and daring and lower youth ratings on prosociality, and by parent ratings of greater negative emotionality and lower prosociality. A measure of working memory did not predict APD symptoms. CONCLUSIONS These findings support future research on the role of these dispositions in the development of antisocial behavior.
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20
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Maternal ratings of ODD symptoms: Subtypes versus severity in a general community sample of children. Compr Psychiatry 2018; 81:81-90. [PMID: 29306067 DOI: 10.1016/j.comppsych.2017.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 11/27/2017] [Accepted: 12/05/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND AND AIMS Oppositional Defiant Disorder (ODD) is a common childhood disorder (American Psychiatric Association [APA], 2000; APA, 2013). The aim of the present study was to ascertain the optimal structure for the ODD symptoms by identifying whether ODD is a qualitatively distinct entity (categorical) or is a continuum, with high levels on this continuum reflecting ODD (quantitative or dimensional view). METHODS Mothers' ratings of the ODD symptoms of 457 children, aged 3 to 15years, as presented in the disruptive behavior rating scale were obtained. Confirmatory factor analysis (CFA), latent class analysis (LCA), and factor mixture modelling (FMM) were applied to determine the best model for oppositional defiant disorder (ODD) symptoms in children. RESULTS The findings provided most support for a FMM with 3 classes (unaffected odd class, at risk class, and affected class) and 3 factors (oppositional, antagonistic, and negative affect). CONCLUSION The findings are discussed in relation to dimensional, categorical, and hybrid (categorical/dimensional) models of ODD symptoms.
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21
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Waldman ID, Poore HE, van Hulle C, Rathouz PJ, Lahey BB. External validity of a hierarchical dimensional model of child and adolescent psychopathology: Tests using confirmatory factor analyses and multivariate behavior genetic analyses. JOURNAL OF ABNORMAL PSYCHOLOGY 2018; 125:1053-1066. [PMID: 27819467 DOI: 10.1037/abn0000183] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Several recent studies of the hierarchical phenotypic structure of psychopathology have identified a General psychopathology factor in addition to the more expected specific Externalizing and Internalizing dimensions in both youth and adult samples and some have found relevant unique external correlates of this General factor. We used data from 1,568 twin pairs (599 MZ & 969 DZ) age 9 to 17 to test hypotheses for the underlying structure of youth psychopathology and the external validity of the higher-order factors. Psychopathology symptoms were assessed via structured interviews of caretakers and youth. We conducted phenotypic analyses of competing structural models using Confirmatory Factor Analysis and used Structural Equation Modeling and multivariate behavior genetic analyses to understand the etiology of the higher-order factors and their external validity. We found that both a General factor and specific Externalizing and Internalizing dimensions are necessary for characterizing youth psychopathology at both the phenotypic and etiologic levels, and that the 3 higher-order factors differed substantially in the magnitudes of their underlying genetic and environmental influences. Phenotypically, the specific Externalizing and Internalizing dimensions were slightly negatively correlated when a General factor was included, which reflected a significant inverse correlation between the nonshared environmental (but not genetic) influences on Internalizing and Externalizing. We estimated heritability of the general factor of psychopathology for the first time. Its moderate heritability suggests that it is not merely an artifact of measurement error but a valid construct. The General, Externalizing, and Internalizing factors differed in their relations with 3 external validity criteria: mother's smoking during pregnancy, parent's harsh discipline, and the youth's association with delinquent peers. Multivariate behavior genetic analyses supported the external validity of the 3 higher-order factors by suggesting that the General, Externalizing, and Internalizing factors were correlated with peer delinquency and parent's harsh discipline for different etiologic reasons. (PsycINFO Database Record
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Dimensional Latent Structure of Early Disruptive Behavior Disorders: A Taxometric Analysis in Preschoolers. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2017; 46:1385-1394. [DOI: 10.1007/s10802-017-0383-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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23
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March-Llanes J, Marqués-Feixa L, Mezquita L, Fañanás L, Moya-Higueras J. Stressful life events during adolescence and risk for externalizing and internalizing psychopathology: a meta-analysis. Eur Child Adolesc Psychiatry 2017; 26:1409-1422. [PMID: 28502034 DOI: 10.1007/s00787-017-0996-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 05/08/2017] [Indexed: 01/09/2023]
Abstract
The main objective of the present research was to analyze the relations between stressful life events and the externalizing and internalizing spectra of psychopathology using meta-analytical procedures. After removing the duplicates, a total of 373 papers were found in a literature search using several bibliographic databases, such as the PsycINFO, Medline, Scopus, and Web of Science. Twenty-seven studies were selected for the meta-analytical analysis after applying different inclusion and exclusion criteria in different phases. The statistical procedure was performed using a random/mixed-effects model based on the correlations found in the studies. Significant positive correlations were found in cross-sectional and longitudinal studies. A transactional effect was then found in the present study. Stressful life events could be a cause, but also a consequence, of psychopathological spectra. The level of controllability of the life events did not affect the results. Special attention should be given to the usage of stressful life events in gene-environment interaction and correlation studies, and also for clinical purposes.
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Affiliation(s)
- Jaume March-Llanes
- Department of Psychology, Faculty of Education, Psychology, and Social Work, University of Lleida, Avda. de l'Estudi General, 4, 25221, Lleida, Spain
| | - Laia Marqués-Feixa
- Department of Evolutionary Biology, Ecology, and Environmental Sciences, Faculty of Biology, University of Barcelona, Biomedicine Institute of the University of Barcelona (IBUB), Barcelona, Spain
| | - Laura Mezquita
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Avda. de Vicent Sos Baynat, s/n, 12701, Castelló De La Plana, Spain
| | - Lourdes Fañanás
- Department of Evolutionary Biology, Ecology, and Environmental Sciences, Faculty of Biology, University of Barcelona, Biomedicine Institute of the University of Barcelona (IBUB), Barcelona, Spain.,Instituto De Salud Carlos III, Centro De Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Jorge Moya-Higueras
- Department of Psychology, Faculty of Education, Psychology, and Social Work, University of Lleida, Avda. de l'Estudi General, 4, 25221, Lleida, Spain. .,Instituto De Salud Carlos III, Centro De Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
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Karlsgodt KH, Bato AA, Ikuta T, Peters BD, DeRosse P, Szeszko PR, Malhotra AK. Functional Activation During a Cognitive Control Task in Healthy Youth Specific to Externalizing or Internalizing Behaviors. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2017. [PMID: 29529408 DOI: 10.1016/j.bpsc.2017.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Externalizing behaviors are negative behaviors expressed outwardly, including rule breaking, aggression, and risk taking; internalizing behaviors are expressed inwardly, including depression, withdrawal, and anxiety. Such behavior can cause problems in early life and predict difficulties across the lifespan. There is evidence for a relationship between executive function and both externalizing and internalizing. However, although these behaviors occur along a spectrum, there is little neuroimaging research on this relationship in typically developing youth. METHODS We assessed 41 youth (10-19 years of age) using the Multi-Source Interference Task during functional magnetic resonance imaging and related the findings to self-reported externalizing and internalizing scores as measured by the Youth Self-Report. We performed a general linear model using FSL software; externalizing, internalizing, age, and sex were included in the model. RESULTS Compared to the control condition, the more difficult Multi-Source Interference Task interference condition was associated with greater engagement of the frontoparietal cognitive control system and decreased engagement of regions in the default mode network, based on a cluster threshold of Z > 3.1 (p = .01). When we examined regions uniquely associated with either internalizing or externalizing, we found that within the same group of subjects, higher externalizing behavior was associated with hyperactivity in the parietal lobe; in contrast, higher internalizing behavior was associated with increased activation in the medial prefrontal cortex. CONCLUSIONS These findings suggest that externalizing and internalizing may be associated with altered, but different, patterns of activation during cognitive control. This has implications for our understanding of the relationship between cognitive control and behavioral problems in youth.
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Affiliation(s)
- Katherine H Karlsgodt
- Department of Psychology, University of California, Los Angeles, Los Angeles, California.
| | - Angelica A Bato
- Feinstein Institute for Medical Research, Manhasset, New York; Zucker Hillside Hospital, Glen Oaks, New York
| | - Toshikazu Ikuta
- Department of Communication Sciences and Disorders, University of Mississippi, Oxford, Mississippi
| | | | - Pamela DeRosse
- Feinstein Institute for Medical Research, Manhasset, New York; Zucker Hillside Hospital, Glen Oaks, New York; Northwell School of Medicine, Hempstead, New York
| | - Philip R Szeszko
- James J. Peters Veterans Affairs Medical Center, Bronx, New York; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anil K Malhotra
- Feinstein Institute for Medical Research, Manhasset, New York; Zucker Hillside Hospital, Glen Oaks, New York; Northwell School of Medicine, Hempstead, New York
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25
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Holla B, Panda R, Venkatasubramanian G, Biswal B, Bharath RD, Benegal V. Disrupted resting brain graph measures in individuals at high risk for alcoholism. Psychiatry Res Neuroimaging 2017; 265:54-64. [PMID: 28531764 DOI: 10.1016/j.pscychresns.2017.05.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 05/03/2017] [Accepted: 05/04/2017] [Indexed: 01/13/2023]
Abstract
Familial susceptibility to alcoholism is likely to be linked to the externalizing diathesis seen in high-risk offspring from high-density alcohol use disorder (AUD) families. The present study aimed at comparing resting brain functional connectivity and their association with externalizing symptoms and alcoholism familial density in 40 substance-naive high-risk (HR) male offspring from high-density AUD families and 30 matched healthy low-risk (LR) males without a family history of substance dependence using graph theory-based network analysis. The HR subjects from high-density AUD families compared with LR, showed significantly reduced clustering, small-worldness, and local network efficiency. The frontoparietal, cingulo-opercular, sensorimotor and cerebellar networks exhibited significantly reduced functional segregation. These disruptions exhibited independent incremental value in predicting the externalizing symptoms over and above the demographic variables. The reduction of functional segregation in HR subjects was significant across both the younger and older age groups and was proportional to the family loading of AUDs. Detection and estimation of these developmentally relevant disruptions in small-world architecture at critical brain regions sub-serving cognitive, affective, and sensorimotor processes are vital for understanding the familial risk for early onset alcoholism as well as for understanding the pathophysiological mechanism of externalizing behaviors.
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Affiliation(s)
- Bharath Holla
- Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore, India.
| | - Rajanikant Panda
- Cognitive Neuroscience Centre and Department of Neuroimaging and Interventional Radiology (NIIR), NIMHANS, Hosur Road, Bangalore, India
| | | | - Bharat Biswal
- Department of Biomedical Engineering, New Jersey Institute of Technology (NJIT), University Heights, Newark, NJ, USA
| | - Rose Dawn Bharath
- Cognitive Neuroscience Centre and Department of Neuroimaging and Interventional Radiology (NIIR), NIMHANS, Hosur Road, Bangalore, India.
| | - Vivek Benegal
- Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore, India.
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Pezzoli P, Antfolk J, Santtila P. Phenotypic factor analysis of psychopathology reveals a new body-related transdiagnostic factor. PLoS One 2017; 12:e0177674. [PMID: 28542328 PMCID: PMC5436748 DOI: 10.1371/journal.pone.0177674] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 05/01/2017] [Indexed: 12/11/2022] Open
Abstract
Comorbidity challenges the notion of mental disorders as discrete categories. An increasing body of literature shows that symptoms cut across traditional diagnostic boundaries and interact in shaping the latent structure of psychopathology. Using exploratory and confirmatory factor analysis, we reveal the latent sources of covariation among nine measures of psychopathological functioning in a population-based sample of 13024 Finnish twins and their siblings. By implementing unidimensional, multidimensional, second-order, and bifactor models, we illustrate the relationships between observed variables, specific, and general latent factors. We also provide the first investigation to date of measurement invariance of the bifactor model of psychopathology across gender and age groups. Our main result is the identification of a distinct "Body" factor, alongside the previously identified Internalizing and Externalizing factors. We also report relevant cross-disorder associations, especially between body-related psychopathology and trait anger, as well as substantial sex and age differences in observed and latent means. The findings expand the meta-structure of psychopathology, with implications for empirical and clinical practice, and demonstrate shared mechanisms underlying attitudes towards nutrition, self-image, sexuality and anger, with gender- and age-specific features.
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Affiliation(s)
- Patrizia Pezzoli
- Department of Psychology, Åbo Akademi University, Turku, Finland
- * E-mail:
| | - Jan Antfolk
- Department of Psychology, Åbo Akademi University, Turku, Finland
- Turku Brain and Mind Centre, Turku, Finland
| | - Pekka Santtila
- Department of Psychology, Åbo Akademi University, Turku, Finland
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Bilgiç A, Tufan AE, Yılmaz S, Özcan Ö, Özmen S, Öztop D, Türkoğlu S, Akça ÖF, Yar A, Işık Ü, Çolak Sivri R, Polat H, Irmak A, Dönmez YE, Çon Bayhan P, Uçur Ö, Cansız MA, Savcı U. Association of Reactive-Proactive Aggression and Anxiety Sensitivity with Internalizing and Externalizing Symptoms in Children with Attention-Deficit/Hyperactivity Disorder. Child Psychiatry Hum Dev 2017; 48:283-297. [PMID: 27033363 DOI: 10.1007/s10578-016-0640-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study evaluates the associations among the symptoms of anxiety, depression, and disruptive behavioral disorders (DBD) in the context of their relationships with reactive-proactive aggression and anxiety sensitivity in children with attention-deficit/hyperactivity disorder (ADHD). The sample consisted of 342 treatment-naive children with ADHD. The severity of ADHD and DBD symptoms were assessed via parent- and teacher-rated inventories. Anxiety sensitivity, reactive-proactive aggression and severity of anxiety and depression symptoms of children were evaluated by self-report inventories. According to structural equation modeling, depression and anxiety scores had a relation with the DBD scores through reactive-proactive aggression. Results also showed a negative relation of the total scores of anxiety sensitivity on DBD scores, while conduct disorder scores had a positive relation with anxiety scores. This study suggests that examining the relations of reactive-proactive aggression and anxiety sensitivity with internalizing and externalizing disorders could be useful for understanding the link among these disorders in ADHD.
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Affiliation(s)
- Ayhan Bilgiç
- Department of Child and Adolescent Psychiatry, Meram School of Medicine, Necmettin Erbakan University, 42090, Meram, Konya, Turkey.
| | - Ali Evren Tufan
- Department of Child and Adolescent Psychiatry, School of Medicine, Izzet Baysal University, Bolu, Turkey
| | - Savaş Yılmaz
- Department of Child and Adolescent Psychiatry, Meram School of Medicine, Necmettin Erbakan University, 42090, Meram, Konya, Turkey
| | - Özlem Özcan
- Department of Child and Adolescent Psychiatry, School of Medicine, Inonu University, Malatya, Turkey
| | - Sevgi Özmen
- Department of Child and Adolescent Psychiatry, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Didem Öztop
- Department of Child and Adolescent Psychiatry, Surp Pirgic Ermenian Hospital, Istanbul, Turkey
| | - Serhat Türkoğlu
- Department of Child and Adolescent Psychiatry, School of Medicine, Selcuk University, Konya, Turkey
| | - Ömer Faruk Akça
- Department of Child and Adolescent Psychiatry, Meram School of Medicine, Necmettin Erbakan University, 42090, Meram, Konya, Turkey
| | - Ahmet Yar
- Department of Child and Adolescent Psychiatry, Konya Education and Research Hospital, Konya, Turkey
| | - Ümit Işık
- Department of Child and Adolescent Psychiatry, Meram School of Medicine, Necmettin Erbakan University, 42090, Meram, Konya, Turkey
| | - Rukiye Çolak Sivri
- Department of Child and Adolescent Psychiatry, Meram School of Medicine, Necmettin Erbakan University, 42090, Meram, Konya, Turkey
| | - Hatice Polat
- Department of Child and Adolescent Psychiatry, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Ayşe Irmak
- Department of Child and Adolescent Psychiatry, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Yunus Emre Dönmez
- Department of Child and Adolescent Psychiatry, School of Medicine, Inonu University, Malatya, Turkey
| | - Pelin Çon Bayhan
- Department of Child and Adolescent Psychiatry, School of Medicine, Inonu University, Malatya, Turkey
| | - Ömer Uçur
- Department of Child and Adolescent Psychiatry, School of Medicine, Inonu University, Malatya, Turkey
| | - Mehmet Akif Cansız
- Department of Child and Adolescent Psychiatry, School of Medicine, Izzet Baysal University, Bolu, Turkey
| | - Uğur Savcı
- Department of Child and Adolescent Psychiatry, School of Medicine, Izzet Baysal University, Bolu, Turkey
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Latent Profiles of Externalizing Psychopathology and Their Relation to Children's Aggression and Social Behavior. J Dev Behav Pediatr 2016; 37:442-50. [PMID: 27152768 DOI: 10.1097/dbp.0000000000000304] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study identified profiles of clinic-referred children with disruptive behavior and determined the association between identified profiles and children's aggression, peer problems, and prosocial skills. METHOD Parents and teachers of 208 children (163 boys) aged 6 to 12 years (Mage = 8.80, SD = 1.75) completed measures to assess children's callous-unemotional (CU) traits, inattentive-impulsive-overactive (IO) and oppositional-defiant (OD) behavior, aggression, and social behaviors. Latent class analysis was used to identify the profiles, and the pseudoclass draw method to test the equality of means for each of the aggression and social behavioral outcomes across the latent classes. RESULTS Five profiles were identified: (1) Low (35.6% of children), with relatively low levels of CU traits and IO and OD behavior; (2) Low-Moderate (30.8%), with low-moderate levels of CU traits, low IO and moderate OD behavior; (3) Moderate (21.6%), with moderate levels of CU traits and IO and moderate-high OD behavior; (4) Moderate-High (7.2%), with moderate-high levels of CU traits, high IO and moderate-high OD behavior; and (5) High (4.8%), with high levels of CU traits, IO and OD behavior. CONCLUSION Children categorized into profiles showed important differences in level of aggression and social behavior. The overlap between CU traits, IO, and OD behavior add to understanding of child psychopathology that influences behavior and clinical outcomes.
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Walton KE, Krueger RF, Elkins I, D'Accordo C, McGue M, Iacono WG. Personality Traits Predict the Developmental Course of Externalizing: A Four-Wave Longitudinal Study Spanning Age 17 to Age 29. J Pers 2016; 85:364-375. [PMID: 26808279 DOI: 10.1111/jopy.12245] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The objective of the present study was to determine whether and how personality predicts the developmental course of externalizing problems, including antisocial behavior and substance dependence. In a large, population-based longitudinal study (N = 1,252), the 11 personality traits assessed by the Multidimensional Personality Questionnaire were measured at age 17, and DSM diagnoses of adult antisocial behavior, alcohol dependence, and drug dependence were obtained at ages 17, 20, 24, and 29. We fit a quadratic multiple indicator latent growth model where the three diagnoses loaded onto an externalizing factor. This model fit the data well, and externalizing increased until it started to decline at age 24. High aggression and low control were the most significant predictors of the development of externalizing, with aggression playing a significant role in the development of externalizing across the 12-year time span, and control predicting the development from age 17 to 24. The findings highlight the importance of considering the developmental course of externalizing in the context of personality and suggest that the specific personality traits of aggression and control might be targeted in externalizing prevention and intervention programs.
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Gregory AM, Sadeh A. Annual Research Review: Sleep problems in childhood psychiatric disorders--a review of the latest science. J Child Psychol Psychiatry 2016; 57:296-317. [PMID: 26412255 DOI: 10.1111/jcpp.12469] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hippocrates flagged the value of sleep for good health. Nonetheless, historically, researchers with an interest in developmental psychopathology have largely ignored a possible role for atypical sleep. Recently, however, there has been a surge of interest in this area, perhaps reflecting increased evidence that disturbed or insufficient sleep can result in poor functioning in numerous domains. This review outlines what is known about sleep in the psychiatric diagnoses most relevant to children and for which associations with sleep are beginning to be understood. While based on a comprehensive survey of the literature, the focus of the current review is on the latest science (largely from 2010). There is a description of both concurrent and longitudinal links as well as possible mechanisms underlying associations. Preliminary treatment research is also considered which suggests that treating sleep difficulties may result in improvements in behavioural areas beyond sleep quality. FINDINGS To maximise progress in this field, there now needs to be: (a) greater attention to the assessment of sleep in children; (b) sleep research on a wider range of psychiatric disorders; (c) a greater focus on and examination of mechanisms underlying associations; (d) a clearer consideration of developmental questions and (e) large-scale well-designed treatment studies. CONCLUSIONS While sleep problems may sometimes be missed by parents and healthcare providers; hence constituting a hidden risk for other psychopathologies - knowing about these difficulties creates unique opportunities. The current excitement in this field from experts in diverse areas including developmental psychology, clinical psychology, genetics and neuropsychology should make these opportunities a reality.
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Affiliation(s)
- Alice M Gregory
- Department of Psychology, Goldsmiths, University of London, New Cross, London, UK
| | - Avi Sadeh
- School of Psychological Sciences, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
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Miller PG, Butler E, Richardson B, Staiger PK, Youssef GJ, Macdonald JA, Sanson A, Edwards B, Olsson CA. Relationships between problematic alcohol consumption and delinquent behaviour from adolescence to young adulthood. Drug Alcohol Rev 2015; 35:317-25. [PMID: 26494311 DOI: 10.1111/dar.12345] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 08/26/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Heavy episodic drinking (HED) has been associated with increased risk for short- and long-term injury and harms, such as violence and delinquent behaviour; however, the temporal relationship between the two remains unclear, particularly on transition to young adulthood. This study investigates transactional pathways between HED and delinquent behaviour from adolescence to emerging adulthood. METHODS Data were drawn from the Australian Temperament Project; a population-based longitudinal study that has followed the health and development of participants (and parents) across 30 years from birth in 1982. The analytic sample was 1650 participants and included five measurement waves spanning adolescence (3 waves: 13-18 years) and young adulthood (2 waves; 19-24 years). RESULTS There was strong continuity across waves of both HED and delinquency, as well as across-time associations between them. Delinquent behaviour in adolescence was associated with up to twofold increases in the odds of HED at each subsequent adolescent wave. HED in the late teens was associated with over fourfold increases in the odds of persistent (two waves) HED in young adulthood. HED in the late teens was associated with increases in the odds of delinquent behaviour in young adulthood (over twofold for male and one and a half-fold for female participants). CONCLUSIONS While delinquent behaviour predicts both future HED and future delinquent behaviour in adolescence, once young people reach the legal drinking age of 18 years, HED becomes a predictor of current and future delinquent behaviour and future HED, suggesting that increased access to alcohol increases the likelihood of young people engaging in delinquent behaviour. [Miller PG, Butler E, Richardson B, Staiger PK, Youssef GJ, Macdonald JA, Sanson A, Edwards B, Olsson CA. Relationships between problematic alcohol consumption and delinquent behaviour from adolescence to young adulthood. Drug Alcohol Rev 2016;35:317-325].
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Affiliation(s)
- Peter G Miller
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University Australia, Geelong, Australia
| | - Erin Butler
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University Australia, Geelong, Australia
| | - Ben Richardson
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University Australia, Geelong, Australia
| | - Petra K Staiger
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University Australia, Geelong, Australia
| | - George J Youssef
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University Australia, Geelong, Australia
| | - Jacqui A Macdonald
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University Australia, Geelong, Australia.,Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Ann Sanson
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Ben Edwards
- Australian Institute of Family Studies, Melbourne, Australia
| | - Craig A Olsson
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University Australia, Geelong, Australia.,Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
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Melegari MG, Nanni V, Lucidi F, Russo PM, Donfrancesco R, Cloninger CR. Temperamental and character profiles of preschool children with ODD, ADHD, and anxiety disorders. Compr Psychiatry 2015; 58:94-101. [PMID: 25636952 DOI: 10.1016/j.comppsych.2015.01.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 12/05/2014] [Accepted: 01/03/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The aim of the present research was to identify profiles of Cloninger's temperament and character dimensions associated with anxiety disorders, oppositional defiant disorder (ODD) and attention- deficit/hyperactive disorder (ADHD) in preschoolers. METHOD The parents of 120 children (mean age=4.65 years; S.D.=.88) completed the Preschool Temperament and Character Inventory (PsTCI). The sample consisted of 4 groups (n=30 per group): ADHD, anxious, ODD and control children. To diagnose the different disorders, the Preschool Age Psychiatric Assessment and Child Behavior Checklist 1.5-5 was administered to the parents. RESULTS The discriminant analysis showed that three temperamental dimensions (Harm Avoidance, Novelty Seeking and Persistence) enabled the correct classification of 75% of cases within their own group, which demonstrated an adequate accuracy rate. The ADHD children showed a temperamental profile that was characterized by high Novelty Seeking, low Reward Dependence and low Persistence, while the anxious children obtained high scores in Harm Avoidance. The profiles of the ODD children shared some common features (high Novelty Seeking) with the ADHD children, but the ODD children were characterized by higher Persistence and Harm Avoidance compared with ADHD children. CONCLUSIONS The present results indicate that Cloninger's temperamental dimensions allow to differentiate the three most frequent psychiatric disorders in preschoolers.
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Affiliation(s)
| | - Valentina Nanni
- Child and Adolescent Mental Health Center "La Scarpetta", ASL RM/A, Rome, Italy
| | - Fabio Lucidi
- Department of Developmental and Social Psychology-Sapienza University of Rome, Rome, Italy
| | - Paolo M Russo
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.
| | | | - C Robert Cloninger
- Center for Well Being, Washington University School of Medicine, St Louis, MO, USA
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Carragher N, Krueger RF, Eaton NR, Slade T. Disorders without borders: current and future directions in the meta-structure of mental disorders. Soc Psychiatry Psychiatr Epidemiol 2015; 50:339-50. [PMID: 25557024 DOI: 10.1007/s00127-014-1004-z] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 12/22/2014] [Indexed: 12/11/2022]
Abstract
PURPOSE Classification is the cornerstone of clinical diagnostic practice and research. However, the extant psychiatric classification systems are not well supported by research evidence. In particular, extensive comorbidity among putatively distinct disorders flags an urgent need for fundamental changes in how we conceptualize psychopathology. Over the past decade, research has coalesced on an empirically based model that suggests many common mental disorders are structured according to two correlated latent dimensions: internalizing and externalizing. METHODS We review and discuss the development of a dimensional-spectrum model which organizes mental disorders in an empirically based manner. We also touch upon changes in the DSM-5 and put forward recommendations for future research endeavors. RESULTS Our review highlights substantial empirical support for the empirically based internalizing-externalizing model of psychopathology, which provides a parsimonious means of addressing comorbidity. CONCLUSIONS As future research goals, we suggest that the field would benefit from: expanding the meta-structure of psychopathology to include additional disorders, development of empirically based thresholds, inclusion of a developmental perspective, and intertwining genomic and neuroscience dimensions with the empirical structure of psychopathology.
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Affiliation(s)
- Natacha Carragher
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, 2052, Australia,
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Wolf EJ, Miller MW, Kilpatrick D, Resnick HS, Badour CL, Marx BP, Keane TM, Rosen RC, Friedman MJ. ICD-11 Complex PTSD in US National and Veteran Samples: Prevalence and Structural Associations with PTSD. Clin Psychol Sci 2015; 3:215-229. [PMID: 25750837 PMCID: PMC4350783 DOI: 10.1177/2167702614545480] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The eleventh edition of the International Classification of Diseases (ICD-11) is under development and current proposals include major changes to trauma-related psychiatric diagnoses, including a heavily restricted definition of posttraumatic stress disorder (PTSD) and the addition of complex PTSD (CPTSD). We aimed to test the postulates of CPTSD in samples of 2695 community participants and 323 trauma-exposed military veterans. CPTSD prevalence estimates were 0.6% and 13% in the community and veteran samples, respectively; one-quarter to one-half of those with PTSD met criteria for CPTSD. There were no differences in trauma exposure across diagnoses. A factor mixture model with two latent dimensional variables and four latent classes provided the best fit in both samples: classes differed by their level of symptom severity but did not differ as a function of the proposed PTSD versus CPTSD diagnoses. These findings should raise concerns about the distinctions between CPTSD and PTSD proposed for ICD-11.
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Affiliation(s)
- Erika J Wolf
- VA National Center for PTSD and Boston University School of Medicine
| | - Mark W Miller
- VA National Center for PTSD and Boston University School of Medicine
| | | | | | | | - Brian P Marx
- VA National Center for PTSD and Boston University School of Medicine
| | - Terence M Keane
- VA National Center for PTSD and Boston University School of Medicine
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Rodgers S, Müller M, Rössler W, Castelao E, Preisig M, Ajdacic-Gross V. Externalizing disorders and substance use: empirically derived subtypes in a population-based sample of adults. Soc Psychiatry Psychiatr Epidemiol 2015; 50:7-17. [PMID: 24907047 DOI: 10.1007/s00127-014-0898-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 05/25/2014] [Indexed: 01/20/2023]
Abstract
PURPOSE Attention-deficit/hyperactivity disorder (ADHD), conduct disorder (CD), and oppositional defiant disorder (ODD) are common externalizing disorders of childhood. The common effects of these disorders on substance abuse need further investigation. The current study investigated the joint clusters of childhood/adolescence ADHD, CD, and ODD, and their influence on substance abuse/dependence in a population-based sample of adults. METHODS The data were drawn from the PsyCoLaus study (n = 3,720) conducted in Lausanne, Switzerland. The population-based sample included 238 subjects meeting criteria for ADHD/ODD/CD diagnoses before the age of 15. Latent class analyses (LCA) were performed to derive comorbidity subtypes, which were subsequently characterized with respect to psychosocial correlates and substance use. RESULTS The best fit in LCAs was achieved with three latent classes: an ADHD subtype (35.7 %); an externalizing multimorbid subtype (33.6 %) involving ODD, ADHD, and CD; and a third subtype with CD (30.7 %). The CD subtype showed the highest association with substance use. Apart from this, the externalizing multimorbid subtype was also significantly linked to substance use. The ADHD subtype had only elevated frequencies for alcohol dependence in comparison with subjects that had no history of ADHD, ODD, and CD during childhood or adolescence. Finally, important interactions between subtypes and sex were observed with regard to substance use. CONCLUSIONS This study provides evidence showing that subtyping the externalizing disorders, ADHD, ODD and CD, along their comorbidity patterns leads to important differences regarding substance use. This could have implications for the etiology, prevention, and treatment of substance use disorders.
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Affiliation(s)
- Stephanie Rodgers
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, PO Box 1930, CH-8021, Zurich, Switzerland,
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Evans BE, Greaves-Lord K, Euser AS, Koning T, Tulen JHM, Franken IHA, Huizink AC. Blunted Heart Rate Response as a Potential Endophenotype of Substance Use Disorders: Evidence from High-Risk Youth. Front Pediatr 2015; 3:66. [PMID: 26284227 PMCID: PMC4517538 DOI: 10.3389/fped.2015.00066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 07/13/2015] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Children of parents with a substance use disorder (CPSUD) are at increased risk for developing problematic substance use later in life. Endophenotypes may help to clarify the mechanism behind this increased risk. However, substance use and externalizing symptoms may confound the relation between dysregulated physiological stress responding and familial risk for substance use disorders (SUDs). METHODS We examined whether heart rate (HR) responses differed between CPSUDs and controls. Participants (aged 11-20 years) were CPSUDs (N = 75) and controls (N = 363), semi-matched on the basis of sex, socioeconomic status, and ethnicity. HR was measured continuously during a psychosocial stress procedure. Substance use and externalizing symptoms were self-reported and mother-reported, respectively. RESULTS A piecewise, mixed-effects model was fit for HR across the stress procedure, with fixed effects for HR reactivity and HR recovery. CPSUDs showed a blunted HR recovery. CPSUDs reported drinking more frequently, were more likely to use tobacco daily, were more likely to report ever use of cannabis and used cannabis more frequently, and exhibited more externalizing symptoms. These variables did not confound the relation between familial risk for SUDs and a blunted HR recovery. CONCLUSION Our findings suggest dysregulated autonomic nervous system (ANS) responding in CPSUDs and contribute to the accumulating evidence for ANS dysregulation as a potential endophenotype for SUDs.
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Affiliation(s)
- Brittany E Evans
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital , Rotterdam , Netherlands ; Department of Developmental Psychology, EMGO Institute for Health and Care Research, VU University Amsterdam , Amsterdam , Netherlands ; Behavioral Science Institute, Radboud University , Nijmegen , Netherlands
| | - Kirstin Greaves-Lord
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital , Rotterdam , Netherlands
| | - Anja S Euser
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital , Rotterdam , Netherlands ; Department of Psychology, Erasmus University Rotterdam , Rotterdam , Netherlands
| | - Tess Koning
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital , Rotterdam , Netherlands
| | - Joke H M Tulen
- Department of Psychiatry, Erasmus University Medical Center , Rotterdam , Netherlands
| | - Ingmar H A Franken
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital , Rotterdam , Netherlands ; Department of Psychology, Erasmus University Rotterdam , Rotterdam , Netherlands
| | - Anja C Huizink
- Department of Developmental Psychology, EMGO Institute for Health and Care Research, VU University Amsterdam , Amsterdam , Netherlands
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Sterba SK. Cautions on the Use of Multiple Imputation When Selecting Between Latent Categorical versus Continuous Models for Psychological Constructs. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2014; 45:167-75. [DOI: 10.1080/15374416.2014.958839] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Sleep in infancy and childhood: implications for emotional and behavioral difficulties in adolescence and beyond. Curr Opin Psychiatry 2014; 27:453-9. [PMID: 25247458 DOI: 10.1097/yco.0000000000000109] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Extensive scientific efforts have been made in an attempt to identify early markers of behavioral and emotional problems. In this context, sleep has received considerable research attention, as it appears to be closely linked to developmental psychopathology. The present review synthesizes some of the most recent findings regarding the concurrent and longitudinal associations between psychopathology and behavioral manifestations of sleep in childhood and adolescence. RECENT FINDINGS Recent evidence suggests that compromised sleep is associated with both internalizing and externalizing problems in childhood and adolescence. Moreover, sleep problems have been shown to predict the development of various emotional and behavioral problems, including depression, anxiety, attention-deficit hyperactivity disorder, risk-taking and aggression. Yet, inconsistencies are apparent, particularly among findings that are based on objective sleep measurement. SUMMARY Taken together, most recent findings suggest that poor sleep in childhood and adolescence constitutes a risk factor for psychopathological symptoms. Accordingly, the importance of early detection and intervention should be a primary goal in clinical settings. In the research domain, the underlying mechanism of these associations should receive future research attention, in an attempt to broaden the understanding of the relationship between sleep and psychopathology.
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Parent training: equivalent improvement in externalizing behavior for children with and without familial risk. J Am Acad Child Adolesc Psychiatry 2014; 53:879-87, 887.e1-2. [PMID: 25062595 PMCID: PMC4492282 DOI: 10.1016/j.jaac.2014.04.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 04/22/2014] [Accepted: 05/29/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The Incredible Years Series intervention has demonstrated efficacy for decreasing conduct disorder (CD) symptomatology in clinically affected youth in multiple randomized controlled trials. Because children with family psychiatric histories of antisocial behavior are at markedly increased risk for enduring symptoms of antisocial behavior (compared with their counterparts with a negative family history), the authors examined whether intervention effects across studies would prevail in that subgroup or would be relatively restricted to children without genetic risk. METHOD A reanalysis was conducted of 5 randomized controlled trials of Incredible Years involving 280 clinically affected children 3 to 8 years of age for whom a family psychiatric history of externalizing behavior in first- and second-degree relatives was ascertained from at least 1 parent. RESULTS Incredible Years equally benefitted children with CD with and without family psychiatric histories of externalizing behavior. Family psychiatric history of externalizing behavior and parental depressive symptomatology predicted greater severity of CD symptomatology at baseline. CONCLUSION The beneficial effects of IY are evident in children with CD, irrespective of whether their conditions are more or less attributable to inherited susceptibility to enduring antisocial syndromes. A next phase of research should address whether earlier implementation of group-based education for parents of young children at increased familial risk for antisocial behavior syndromes-before the development of disruptive patterns of behavior-would result in even more pronounced effects and thereby constitute a cost-effective, targeted, preventive intervention for CD.
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Carragher N, Krueger RF, Eaton NR, Markon KE, Keyes KM, Blanco C, Saha TD, Hasin DS. ADHD and the externalizing spectrum: direct comparison of categorical, continuous, and hybrid models of liability in a nationally representative sample. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1307-17. [PMID: 24081325 PMCID: PMC3972373 DOI: 10.1007/s00127-013-0770-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 09/18/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Alcohol use disorders, substance use disorders, and antisocial personality disorder share a common externalizing liability, which may also include attention-deficit hyperactivity disorder (ADHD). However, few studies have compared formal quantitative models of externalizing liability, with the aim of delineating the categorical and/or continuous nature of this liability in the community. This study compares categorical, continuous, and hybrid models of externalizing liability. METHOD Data were derived from the 2004-2005 National Epidemiologic Survey on Alcohol and Related Conditions (N = 34,653). Seven disorders were modeled: childhood ADHD and lifetime diagnoses of antisocial personality disorder (ASPD), nicotine dependence, alcohol dependence, marijuana dependence, cocaine dependence, and other substance dependence. RESULTS The continuous latent trait model provided the best fit to the data. Measurement invariance analyses supported the fit of the model across genders, with females displaying a significantly lower probability of experiencing externalizing disorders. Cocaine dependence, marijuana dependence, other substance dependence, alcohol dependence, ASPD, nicotine dependence, and ADHD provided the greatest information, respectively, about the underlying externalizing continuum. CONCLUSIONS Liability to externalizing disorders is continuous and dimensional in severity. The findings have important implications for the organizational structure of externalizing psychopathology in psychiatric nomenclatures.
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Affiliation(s)
- Natacha Carragher
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, 2052, Australia,
| | - Robert F. Krueger
- Department of Psychology, University of Minnesota, 75 East River Road, Minneapolis, MN 55455-0344, USA
| | - Nicholas R. Eaton
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794-2500, USA
| | | | - Katherine M. Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 1051 Riverside Drive 123, New York, NY 10032, USA
| | - Carlos Blanco
- New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, 1051 Riverside Drive, Unit 69, New York, NY 10032, USA
| | - Tulshi D. Saha
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Bethesda, USA
| | - Deborah S. Hasin
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive No. 123, New York, NY 10032, USA
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The externalizing spectrum in youth: Incorporating personality pathology. J Adolesc 2014; 37:659-68. [DOI: 10.1016/j.adolescence.2013.10.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 09/05/2013] [Accepted: 10/23/2013] [Indexed: 11/16/2022]
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Barry TD, Marcus DK, Barry CT, Coccaro EF. The latent structure of oppositional defiant disorder in children and adults. J Psychiatr Res 2013; 47:1932-9. [PMID: 24075326 PMCID: PMC3825265 DOI: 10.1016/j.jpsychires.2013.08.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 08/20/2013] [Accepted: 08/26/2013] [Indexed: 11/15/2022]
Abstract
An understanding of the latent structure of oppositional defiant disorder (ODD) is essential for better developing causal models, improving diagnostic and assessment procedures, and enhancing treatments for the disorder. Although much research has focused on ODD-including recent studies informing the diagnostic criteria for DSM-5-research examining the latent structure of ODD is sparse, and no known study has specifically undertaken a taxometric analysis to address the issue of whether ODD is a categorical or dimensional construct. To address this gap, the authors conducted two separate studies using a set of taxometric analyses with data from the NICHD Study of Early Child Care and Youth Development (child study; n = 969) and with data from a large mixed sample of adults, which included participants reporting psychiatric difficulties as well as healthy controls (adult study; n = 600). The results of a variety of non-redundant analyses across both studies revealed a dimensional latent structure for ODD symptoms among both children and adults. These findings are consistent with previous studies that have examined latent structure of related constructs (e.g., aggression, antisocial behavior) as well as studies that have examined the dimensional versus categorical structure of ODD using methods other than taxometric analysis.
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Affiliation(s)
- Tammy D. Barry
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS 39406
| | - David K. Marcus
- Department of Psychology, Washington State University, Pullman, WA 99164
| | - Christopher T. Barry
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS 39406
| | - Emil F. Coccaro
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637
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