Relational Aggression in Adolescents with Conduct Disorder: Sex Differences and Behavioral Correlates

Parenting practices, bullying perpetration, and conduct problems among Ukrainian children

BACKGROUND

Positive and consistent parenting practices are associated with the positive mental health of children. However, little is understood about the implications of the Russian military invasion on family dynamics in Ukraine.

OBJECTIVE

This research aims to estimate the prevalence of childhood conduct disorder (CD) and bullying perpetration and their association with parenting practices among Ukrainian children living in proximity to the war.

PARTICIPANTS AND SETTING

The sample included 2763 Ukrainian children ranging in age from 10 to 17 years (M = 12.6, SD = 1.23), 56.23 % girls. Children attended public secondary schools in Eastern Ukraine, mostly in Kharkiv and Kharkiv oblasts (regions).

METHODS

Children reported on sociodemographic characteristics, parenting practices, CD, and bullying perpetration using smartphones, computers, or tablets, at home or in school IT classrooms. Data were collected on a secure online platform.

RESULTS

Children reported teasing (23.68 %), spreading rumors (24.51 %), helping to harass (17.31 %), threatening to hurt or hit (21.65 %) other students, breaking rules (28.13 %), getting in fights (17.13 %), cheating (43.16 %), and being spanked by parents (30 %). Also, 1.83 % of girls and 3.43 % of boys met a borderline cutoff for CD. Lack of parent involvement was associated with increased CD and bullying risks. Poor parent monitoring, inconsistent discipline, and corporal punishment were associated with increasaed CD but not with bullying. CD mediated the association of poor monitoring, inconsistent discipline, and corporal punishment with bullying.

CONCLUSION

Parental involvement, monitoring, consistent discipline, and avoidance of physical punishments are important practices that can reduce disruptive behavior and aggressive tendencies among Ukrainian children affected by the Russian war.

Perpetrators and victims of cyberbullying among youth with conduct disorder

Due to modern technological innovations, aggressive behaviors have expanded into the cyberspace, creating a new matter of public concern: cyberbullying. Antisocial and aggressive behaviors, including bullying are characteristic for children and adolescents diagnosed with conduct disorder (CD), raising the question whether these youths are highly involved in cyberbullying experiences, too. 206 participants with CD versus typically developing controls (TDCs) aged 9-19 years (57% girls) were included in the study. Individuals completed several self-report measures investigating cyber- and traditional bullying experiences, and hierarchical multiple regression analyses were conducted to explain the relationship between cyberbullying victimization and perpetration with demographic and clinical variables. Experiences of cyberbullying victimization and perpetration were significantly higher among youth with CD compared to TDCs, and this was accompanied by significantly higher scores on a measure of traditional bullying in CD versus TDCs. CD diagnosis, female sex and higher levels of callous-unemotional (CU) traits were each uniquely associated with increased experiences of cyberbullying victimization, whereas CD diagnosis, higher levels of CU traits and older age were each uniquely associated with increased experiences of cyberbullying perpetration. Individuals with CD, compared to TDCs are at higher risk of becoming cyberbully victims and perpetrators, hence representing an important novel aspect in the assessment and treatment of these youths.

Contemporary diagnosis and treatment of conduct disorder in youth

INTRODUCTION

Conduct disorder (CD) is characterized by repetitive and persistent antisocial behaviors, being among the most frequently reported reasons of referral in youth. CD is a highly heterogeneous disorder, with possible specifiers defined according to age at onset, Limited Prosocial Emotions (LPE) otherwise known as Callous-Unemotional (CU) traits, Emotional Dysregulation (ED), and patterns of comorbidity, each with its own specific developmental trajectories.

AREAS COVERED

The authors review the evidence from published literature on the clinical presentations, diagnostic procedures, psychotherapeutic and psychoeducational approaches, and pharmacological interventions from RCT and naturalistic studies in youth. Evidence from studies including youths with LPE/CU traits, ED and aggression are also reviewed, as response moderators.

EXPERT OPINION

Due to its clinical heterogeneity, relevant subtypes of CD should be carefully characterized to gain reliable information on prognosis and treatments. Thus, disentangling this broad category in subtypes is crucial as a first step in diagnosis. Psychosocial interventions are the first option, possibly improving LPE/CU traits and ED, especially if implemented early during development. Instead, limited information, based on low-quality studies, supports pharmacological options. Second-generation antipsychotics, mood stabilizers, and stimulants are first-line medications, according to different target symptoms, such as aggression and emotional reactivity. Developmental pathways including ADHD suggest a specific role of psychostimulants.

Systematic Review and Meta-analysis: Psychosocial Treatments for Disruptive Behavior Symptoms and Disorders in Adolescence

OBJECTIVE

Disruptive behavior disorders (DBDs) represent a common motive for referral among youths. This meta-analysis aimed at estimating the efficacy of psychosocial interventions for adolescents with DBDs.

METHOD

A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant systematic review of MEDLINE/PubMED/PsycINFO/Cochrane Central Register of Controlled Trials was conducted. Eligible studies were randomized controlled trials (RCTs) administering psychosocial interventions to adolescents with DBD, published before April 5, 2020. From the initial set of 6,006 records, 17 RCTs involving 18 cohorts (16 publications) were subjected to a random-effect meta-analysis (involving sensitivity, subgroup, and meta-regression analyses). Primary and secondary outcomes were externalizing symptoms at RCT endpoint (ie, standardized mean difference [SMD]) and acceptability (drop-out odds ratio [OR]), respectively. Risk of bias was assessed using the Risk of Bias 2 tool.

RESULTS

A total of 17 RCTs, involving 1,954 adolescents, were included. The mean age was 14.09 (SD 1.33) years; 61% were male. The mean RCT duration was 12 weeks, with a mean follow-up of 8 (SD 3.98) months. Concern over risk of bias emerged in 12 studies, with high concern in 6. Psychosocial interventions had a large effect size at RCT endpoint (SMD = 0.98, 95% CI = -0.55 to -1.38, k = 18) and were acceptable (drop-out OR = 1.29, 95% CI = 0.62-2.70, k = 13). However, this beneficial effect did not persist at follow-up (SMD = -0.36, 95% CI = 0.06 to -0.78, k = 10). Family format was the most effective variable. No other clinically significant moderator was found.

CONCLUSION

Psychosocial interventions involving the families of DBD adolescents are effective and acceptable in the short term. Future studies should focus on strategies to achieve their long-term efficacy.

Synthetic Oxytocin and Vasopressin Act Within the Central Amygdala to Exacerbate Aggression in Female Wistar Rats

Exacerbated aggression is a high-impact, but poorly understood core symptom of several psychiatric disorders, which can also affect women. Animal models have successfully been employed to unravel the neurobiology of aggression. However, despite increasing evidence for sex-specificity, little is known about aggression in females. Here, we studied the role of the oxytocin (OXT) and arginine vasopressin (AVP) systems within the central amygdala (CeA) on aggressive behavior displayed by virgin female Wistar rats using immunohistochemistry, receptor autoradiography, and neuropharmacology. Our data show that CeA GABAergic neurons are activated after an aggressive encounter in the female intruder test. Additionally, neuronal activity (pERK) negatively correlated with the display of aggression in low-aggressive group-housed females. Binding of OXT receptors, but not AVP-V1a receptors, was increased in the CeA of high-aggressive isolated and trained (IST) females. Finally, local infusion of either synthetic OXT or AVP enhanced aggression in IST females, whereas blockade of either of these receptors did not affect aggressive behavior. Altogether, our data support a moderate role of the CeA in female aggression. Regarding neuropeptide signaling, our findings suggest that synthetic, but not endogenous OXT and AVP modulate aggressive behavior in female Wistar rats.

Sex differences in psychiatric comorbidity and clinical presentation in youths with conduct disorder

BACKGROUND

Conduct disorder (CD) rarely occurs alone but is typically accompanied by comorbid psychiatric disorders, which complicates the clinical presentation and treatment of affected youths. The aim of this study was to investigate sex differences in comorbidity pattern in CD and to systematically explore the 'gender paradox' and 'delayed-onset pathway' hypotheses of female CD.

METHODS

As part of the FemNAT-CD multisite study, semistructured clinical interviews and rating scales were used to perform a comprehensive phenotypic characterization of 454 girls and 295 boys with CD (9-18 years), compared to 864 sex- and age-matched typically developing controls.

RESULTS

Girls with CD exhibited higher rates of current major depression, anxiety disorders, post-traumatic stress disorder and borderline personality disorder, whereas boys with CD had higher rates of current attention-deficit/hyperactivity disorder. In line with the 'gender paradox' hypothesis, relative to boys, girls with CD showed significantly more lifetime psychiatric comorbidities (incl. Alcohol Use Disorder), which were accompanied by more severe CD symptoms. Female and male youths with CD also differed significantly in their CD symptom profiles and distribution of age-of-onset subtypes of CD (i.e. fewer girls with childhood-onset CD). In line with the 'delayed-onset pathway' hypothesis, girls with adolescent-onset CD showed similar levels of dimensional psychopathology like boys with childhood-onset CD, while boys with adolescent-onset CD had the lowest levels of internalizing psychopathology.

CONCLUSIONS

Within the largest study of CD in girls performed to date, we found compelling evidence for sex differences in comorbidity patterns and clinical presentation of CD. Our findings further support aspects of the 'gender paradox' and 'delayed-onset pathway' hypotheses by showing that girls with CD had higher rates of comorbid lifetime mental disorders and functional impairments, and they usually developed CD during adolescence. These novel data on sex-specific clinical profiles of CD will be critical in informing intervention and prevention programmes.

Normative data for the self-reported and parent-reported Strengths and Difficulties Questionnaire (SDQ) for ages 12-17

BACKGROUND

The Strengths and Difficulties Questionnaire (SDQ) is widely used to screen for psychosocial problems among adolescents. As the severity of such problems is known to be related to age and gender, screening could be improved by interpreting SDQ scale scores with age-specific and perhaps gender-specific norms. Up to now, such norms are lacking. The aim of the current study is to present gender-specific and joint normative data per year of age for the Dutch self-reported and parent-reported SDQ versions for use among 12- to 17-year-old adolescents.

METHODS

The norm groups for the self-reported and parent-reported SDQ versions consisted of 993 adolescents and 736 parents, respectively, from the general Dutch population. Per SDQ version, both gender-specific norms and joint norms (percentiles and cutoffs) per year of age were calculated through regression-based norming (Rigby in J Roy Stat Soc Ser C 54:507, 2005). Additionally, these norms were compared to the widely used British norms that are neither age-specific nor gender-specific.

RESULTS

By design, gender-specific 'abnormal' cutoffs (i.e., cutoffs aimed at identifying max. 10% of the most extremely scoring males and max. 10% of the most extremely scoring females) resulted in about equal percentages of 'abnormal' scoring male and female adolescents per SDQ scale. In contrast, joint 'abnormal' cutoffs (i.e., cutoffs aimed at identifying max. 10% of the most extremely scoring adolescents) resulted in relatively more male (7.6 to 13.6%, depending on age) than female (3.3 to 8.9%, depending on age) adolescents as scoring 'abnormal' on scales measuring externalizing behavior (self-reported and parent-reported SDQ versions), and relatively more female (3.9 to 14.3%, depending on age) than male (1.8 to 6.9%, depending on age) adolescents as scoring 'abnormal' on scales measuring internalizing behavior (self-reported SDQ version). In both types of norms, minor age effects were present. Among Dutch adolescents, the British norms yielded detection rates much lower than the expected 10%.

CONCLUSIONS

Our findings indicate that detection rates depend on the reference group that is used (British or Dutch general adolescent population; specific gender group or not). The normative data in this paper facilitate the comparison of an adolescent's scores to different reference groups, and allow for cross-country/cultural comparisons of adolescents' psychosocial behavior.

Neuroendocrine regulation of female aggression

Classically the neurobiology of aggression has been studied exclusively in males. Thus, females have been considered mildly aggressive except during lactation. Interestingly, recent studies in rodents and humans have revealed that non-lactating females can show exacerbated and pathological aggression similarly to males. This review provides an overview of recent findings on the neuroendocrine mechanisms regulating aggressive behavior in females. In particular, the focus will be on novel rodent models of exaggerated aggression established in non-lactating females. Among the neuromodulatory systems influencing female aggression, special attention has been given to sex-steroids and sex-steroid-sensitive neuronal populations (i.e., the core nuclei of the neural pathway of aggression) as well as to the neuropeptides oxytocin and vasopressin which are major players in the regulation of social behaviors.

Oxytocin and vasopressin within the ventral and dorsal lateral septum modulate aggression in female rats

In contrast to male rats, aggression in virgin female rats has been rarely studied. Here, we established a rat model of enhanced aggression in females using a combination of social isolation and aggression-training to specifically investigate the involvement of the oxytocin (OXT) and arginine vasopressin (AVP) systems within the lateral septum (LS). Using neuropharmacological, optogenetic, chemogenetic as well as microdialysis approaches, we revealed that enhanced OXT release within the ventral LS (vLS), combined with reduced AVP release within the dorsal LS (dLS), is required for aggression in female rats. Accordingly, increased activity of putative OXT receptor-positive neurons in the vLS, and decreased activity of putative AVP receptor-positive neurons in the dLS, are likely to underly aggression in female rats. Finally, in vitro activation of OXT receptors in the vLS increased tonic GABAergic inhibition of dLS neurons. Overall, our data suggest a model showing that septal release of OXT and AVP differentially affects aggression in females by modulating the inhibitory tone within LS sub-networks.

The Use of Indirect Aggression among Boys and Girls with and without Conduct Problems: Trajectories from Childhood to Adolescence

Though conceptually distinct from other behavior problems, indirect aggression (IA) is correlated with physical aggression and is linked to oppositional defiant disorder and conduct disorder from childhood to adolescence. Thus, IA could be part of the clinical picture of children with identified conduct problems (CP). However, trajectories of IA have not been studied in children with CP. In the present study, we evaluated and compared the mean trajectory of IA from 7 to 14 years of age in children with (n = 328; 47.6% girls) and without (n = 320; 51.3% girls) early clinically significant CP using both parent and teacher ratings. We then examined if sub-groups of children distinguished themselves by their use of IA over time and tested for sex differences. Latent growth models showed that children with CP used IA at higher rates over time than children without CP. Regardless of this higher frequency, the use of IA in both groups of children was best described by down-turned curvilinear trajectories peaking at 10 years of age. Growth mixture models showed that children without CP, according to parent and teacher ratings, and children with CP, according to parent ratings, both followed two trajectories of IA over time, with, respectively, 10% to 14% of them following a high trajectory. As for sex differences, the use of IA of boys and girls without CP did not differ, but differences emerged for children with CP, with girls using IA more frequently. The clinical implications of the findings are discussed.

Lower Digit Ratio (2D:4D) Indicative of Excess Prenatal Androgen Is Associated With Increased Sociability and Greater Social Capital

Positive social interactions are crucial for human well-being. Elevated prenatal exposure to testosterone as indicated by a low second-to-fourth finger length ratio (2D:4D) relates to more aggressive/hostile behavior in men of low 2D:4D, especially in challenging situations. How much people enjoy interacting with others is determined by the personality trait sociability. Given its role in approach and avoidance behavior, sociability might also be influenced by prenatal sex hormones, but studies are inconclusive so far. Here, we investigated the association between 2D:4D and the personality trait sociability complemented by personal social capital and personal social network size, in a population-based cohort of 4998 men. Lower 2D:4D correlated significantly with higher trait sociability, bigger personal social capital, and larger personal social network size. These effects were consistent across both hands separately and their mean value. Furthermore, both factors of sociability (1) liking party and company of friends and (2) isolation intolerance, correlated significantly with the prenatal testosterone marker. The exploratory analysis revealed no link between 2D:4D and responses to the personality trait aggression items or items of anti-social-personality disorder. Our data suggest that prenatal androgen exposure organizes the brain with lasting effects on social behavior.