Female conduct disorder: health status in young adulthood

Psychopathy in women: insights from neuroscience and ways forward for research

Psychopathy is a severe form of personality disturbance, resulting in a detrimental impact on individuals, healthcare systems, and society as a whole. Until relatively recently, most research in psychopathy has focused on male samples, not least because of its link with criminal behavior and the large proportion of violent crime committed by men. However, psychopathy in women also leads to considerable problems at an individual and societal level, including substance misuse, poor treatment outcomes, and contribution to ever-increasing numbers of female prisoners. Despite this, due to relative neglect, most research into adult female psychopathy is underpowered and outdated. We argue that the field needs revitalizing, with a focus on the developmental nature of the condition and neurocognitive research. Recent work international consortia into conduct disorder in female youth-a precursor of psychopathy in female adults-gives cause for optimism. Here, we outline key strategies for enriching research in this important field with contemporary approaches to other psychiatric conditions.

Testing gene by community disadvantage moderation of sexual health outcomes among urban women

We examined whether the interplay between community disadvantage and a conduct disorder polygenic risk score (CD PRS) was associated with sexual health outcomes among urban women. Participants (N = 511; 75.5% African American) were originally recruited to participate in a school-based intervention and were followed into adulthood. Community disadvantage was calculated using census data when participants were in first grade. At age 20, blood or saliva samples were collected and participants reported on their condom use, sexual partners, and sexually transmitted infections. A CD PRS was created based on a genome-wide association study conducted by Dick et al. [2010]. Higher levels of community disadvantage was associated with greater sexually transmitted infections among women with a higher CD PRS. Implications of the study findings are discussed.

Impact of persistent and adolescent-limited antisocial behaviour on adult health outcomes

BACKGROUND

Persistent engagement in antisocial behaviour across developmental periods is thought to increase the risk for early disease morbidity. However, less is known about potential adverse health outcomes among the much larger subset of individuals with antisocial behaviour limited to adolescence.

METHODS

Using data from the Providence, Rhode Island cohort of the Collaborative Perinatal Project, we examined the association between developmentally based subtypes of antisocial behaviour and health outcomes (n=801). Official arrest records and self-reports of engagement in antisocial behaviour were used to classify participants into antisocial groups (persistent into adulthood, adolescent-limited, no significant problems) that were contrasted across important adult health indicators.

RESULTS

With few exceptions, those with persistent antisocial behaviour had the highest prevalence of each health problem. Compared to those with no antisocial behaviour, participants with persistent problems had poorer overall health and significantly elevated odds of cardiovascular problems, wheezing, lower back pain, cancer, serious injury and emergency department visits. Those with adolescent-limited behaviour experienced significantly increased odds of health concerns including poorer overall health, hypercholesterolaemia, acute respiratory problems and wheezing, lower back pain and emergency department visits compared to participants with no antisocial behaviour. Both antisocial groups reported barriers to healthcare access.

CONCLUSIONS

Findings highlight the impact of persistent antisocial behaviour on adult health, and suggest that antisocial behaviour limited to adolescence is also an important marker of poor health. Given that antisocial behaviour during adolescence is an important early marker of adverse health outcomes, youth exhibiting serious behavioural problems should be targeted for preventive interventions.

Do girls with depressive symptoms exhibit more physical aggression than boys? A cross sectional study in a national adolescent sample

BACKGROUND

The relationship between depression and aggressive behaviors in adolescents has previously been reported in clinical and epidemiological studies. However, there is conflicting evidence concerning the effect of gender on this relationship. This study tested whether the link between depressive symptoms and physical aggression differed between boys and girls in a large community-based sample of adolescents.

METHODS

A cross-sectional sample of adolescents aged 15-19 (N = 6,677) was studied within the 2007 ESPAD national survey. Depressive symptoms were assessed using the Adolescent Depression Rating Scale. We distinguished adolescents with subthreshold levels of depressive symptoms and adolescents with clinically significant levels of depressive symptoms. Physical aggressive behaviors in the last year were reported using items from the Antisocial Behavior Scale.

RESULTS

After adjusting for confounding variables, the odds-ratio between depressive symptoms and physical aggressive behaviors was around 1.4. This relationship was stronger for girls than for boys in presence of clinically significant levels of depressive symptoms, but did not differ between the genders in the case of subthreshold levels of depressive symptoms.

CONCLUSIONS

Girls with severe depressive symptoms were more likely to present physical aggressive behaviors than boys. Future studies will be needed to explore the role of irritability in these differences.

Callous-unemotional traits and conduct disorder symptoms as prospective risk factors for adolescent sexual activity

Conduct disorder (CD) has been shown to increase risk for adolescent sexual activity and pregnancy. Despite increasing evidence underscoring callous-unemotional (CU) traits as a marker for youth with CD prone to especially poor outcomes, researchers have yet to explore whether CU traits confer additional risk of early sexual intercourse, unprotected sex, and pregnancy. The Developmental Pathways Project sample, including 471 ethnically diverse 6th-grade boys and girls followed into 12th grade, was used to examine whether CU traits and CD symptoms in 6th grade uniquely and/or synergistically predicted having sexual intercourse by age 13 as well as unprotected sex and pregnancy by 12th grade. Parent-rated CU traits and CD symptoms interacted to predict young adolescents having sexual intercourse, such that youth with elevated CU traits and CD symptoms in 6th grade were more likely to reporting having sex by age 13 than those with low CU traits and/or low CD symptoms. Elevated CD symptoms, but not CU traits, uniquely increased risk of pregnancy by 12th grade. Neither CU traits nor CD symptoms predicted engagement in unprotected sex in 12th grade. Our findings indicate that adolescents with conduct problems and CU traits are especially at risk for early sexual intercourse. Conversely, elevated CU traits do not appear to increase risk of unprotected sex or pregnancy among young adolescents with conduct problems. Research is needed to replicate these findings and to explore mechanisms underlying the association between CU traits, CD symptoms, and early adolescent sexual activity.

Women with Childhood ADHD: Comparisons by Diagnostic Group and Gender

This study compared adult women with childhood ADHD to adult women without childhood ADHD and to adult men with childhood ADHD. The participants, all from a larger longitudinal study, included 30 women and 30 men (approximately age 23 to 24) with childhood ADHD, and 27 women without ADHD. Women with childhood ADHD were matched to comparison women on age, ethnicity, and parental education, and to men with childhood ADHD on age, ethnicity, and IQ. Self- and parent-reports of internalizing, interpersonal, academic, and job impairment, as well as substance use and delinquency indicated group differences on measures of self-esteem, interpersonal and vocational functioning, as well as substance use. Follow-up planned comparison tests revealed that almost all of these differences emerged by diagnostic status, and not by gender. This study adds to research on the negative adult outcomes of ADHD and demonstrates that the outcomes of men and women with childhood ADHD are relatively similar.

Prevalence of physical health problems among youth entering residential treatment

OBJECTIVE

To examine the prevalence of physical health problems among youth entering residential treatment.

PATIENTS AND METHODS

The sample included 1744 youth (mean age: 14.6 ± 1.8 years) entering a large residential treatment program between 2000 and 2010. Youth received an intake medical evaluation, including a review of available records, detailed medical history, and physical examination. Medical conditions present at the time of the evaluation were recorded by the examining physician and later coded by the research team. Only diagnoses recognized by the International Classification of Diseases, 10th Revision, were included in the analyses. To maintain the focus on physical health problems, behavioral and emotional disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision were excluded. Obesity, acne, and allergies were also excluded.

RESULTS

Approximately one-third (33.7%) of youth had a physical health diagnosis at the time of intake. Asthma was the most prevalent condition diagnosed (15.3% of the sample). Girls were significantly more likely to have a diagnosis than were boys (37.1% vs 31.5%). Age was not associated with diagnostic status. Rates of physical health conditions differed significantly by ethnicity: black (36.4%) and white (35.4%) youth had the highest rates, and Hispanic youth (23.2%) had the lowest.

CONCLUSIONS

Youth who enter residential treatment have high rates of physical health conditions. These problems could complicate mental health treatment and should be considered in multidisciplinary treatment planning.

Bone mass, depressive, and anxiety symptoms in adolescent girls: variation by smoking and alcohol use

PURPOSE

The purpose of the study was to examine (a) the association between depressive and anxiety symptoms with bone health, (b) the association of smoking or alcohol use with bone health, and, in turn (c) whether the association between depressive and anxiety symptoms with bone health varied by smoking or alcohol use individually or by combined use. Bone health included total body bone mineral content (TB BMC) and bone mineral density (BMD) of the lumbar spine, total hip, and femoral neck. Previously published data have not examined these issues in adolescence, a period when more than 50% of bone mass is accrued.

METHODS

An observational study enrolled 262 healthy adolescent girls by age cohort (11, 13, 15, and 17 years). Participants completed questionnaires and interviews on substance use, depressive symptoms, and anxiety. BMC and BMD were measured by dual-energy X-ray absorptiometry.

RESULTS

Higher depressive symptoms were associated with lower TB BMC and BMD (total hip, femoral neck). Those with the lowest level of smoking had higher BMD of the hip and femoral neck, whereas no main effect differences were noted by alcohol use. Regular users of both cigarettes and alcohol demonstrated a stronger negative association between depressive symptoms and TB BMC as compared with nonusers/experimental users and regular alcohol users. Findings were parallel for anxiety symptoms.

CONCLUSION

Depressive and anxiety symptoms may negatively influence bone health in adolescent girls. Consideration of multiple substances, rather than cigarettes or alcohol separately, may be particularly informative with respect to the association of depression with bone health.

Morningness/eveningness, pubertal timing, and substance use in adolescent girls

The purpose of this study was to examine the associations between Morningness/Eveningness (M/E; a measure of sleep-wake preference) and alcohol, cigarette, and marijuana use as well as the interaction of M/E and pubertal timing. The data represent baseline measures from a longitudinal study examining the association of psychological functioning and smoking with reproductive and bone health in 262 adolescent girls (11-17 years). The primary measures used for this study were pubertal timing (measured by age at menarche), the Morningness/Eveningness scale, and substance use (alcohol, cigarettes, and marijuana). Multiple group path modeling showed that there was a significant interaction between pubertal timing and M/E on cigarette use. The direction of the parameter estimates indicated that for the early and on-time groups, Evening preference was associated with more cigarette use. For the late timing group the association was not significant. The results point to the need to consider sleep preference as a characteristic that may increase risk for substance use in adolescents.

Morbidity and mortality risk among the "forgotten few": why are girls in the justice system in such poor health?

The present study assessed the physical health of a population of girls sentenced to custody in a large US State via medical examinations and clinical assessments in adolescence and young adulthood. Findings indicated that injuries, obesity, and sexually transmitted diseases were the norm, with over 50% of the population meeting criteria for each of these health problems. A dose-response relationship was documented between childhood victimization and injuries and injury risk in adolescence and self-harm, HIV risk, physical health symptoms, and hospitalizations in young adulthood. The relationship between childhood victimization and poor adult physical health was fully mediated by health-risk behaviors in adolescence. Clinical and policy implications of the high mortality and morbidity risk among female juvenile offenders are discussed.

Prevalence and correlates of internalizing mental health symptoms among CSHCN

OBJECTIVES

This study provides nationally representative prevalence estimates of internalizing mental health symptoms among children with special health care needs (CSHCN) and identifies significant covariates of these symptoms by using multivariate regression. Internalizing symptoms include feeling anxious and depressed.

METHODS

Data were obtained from the 2005-2006 National Survey of Children with Special Health Care Needs, a nationally representative, parent-reported, cross-sectional survey of 40 465 CSHCN. The presence of internalizing mental health symptoms was assessed by using 2 binary items capturing whether a child had or experienced difficulty with depression, anxiety, disordered eating, or other emotional problems. The odds of experiencing internalizing symptoms were assessed by using multivariate regression, controlling for sociodemographic, health-related, and burden-related covariates.

RESULTS

A total of 31.9% of CSHCN 3 to 17 years of age experienced internalizing mental health symptoms. Multivariate logistic regression showed internalizing symptoms to be strongly associated with female gender, older age, and frequent activity limitations, as well as externalizing mental health symptoms and conditions with behavioral components. Children with behavior problems had 6 times the odds of internalizing symptoms (adjusted odds ratio [aOR]: 5.95 [95% confidence interval [CI]: 5.30-6.69]), whereas children with autism spectrum disorder had 3 times the odds (aOR: 3.00 [95% CI: 2.39-3.77]). Increased odds of symptoms also were associated with frequent headaches (aOR: 1.76 [95% CI: 1.45-2.13]) and chronic pain (aOR: 1.46 [95% CI: 1.22-1.75]). Odds of symptoms were greater for children living in households that experienced employment changes or financial burdens resulting from the children's needs.

CONCLUSIONS

Internalizing mental health symptoms are common among CSHCN. Findings may help caregivers focus screening and prevention efforts for high-risk groups in this heterogeneous population.

The impact of delinquency on young adult sexual risk behaviors and sexually transmitted infections

PURPOSE

Youth in the juvenile justice system have increased sexual risk behavior and sexually transmitted infections (STI). However, research exploring the effect of self-reported delinquency on sexual risk behavior and STI is limited, and results vary depending on the populations studied. Therefore, we used nationally representative data to examine the longitudinal association between delinquent behavior, sexual risk behavior, and STI among adolescents and young adults.

METHODS

We used a sample of 10,828 participants from the National Longitudinal Study of Adolescent and Health. Outcomes included STI and sexual risk behavior from Wave III (17-27-year-olds). Predictors for the generalized linear regression models (stratified by gender) include race, age, education, relationship status at Wave III, and delinquent behavior groups (life-course persistent, adolescence-limited, late-onset and nondelinquency).

RESULTS

None of the delinquency groups were associated with young adult STI. Only life-course persistent delinquency was associated consistently with sexual risk behavior (except for condom use). The adolescence-limited and late-onset groups had limited effects on sexual risk outcomes.

CONCLUSIONS

Life-course persistent delinquency influences the expression of young adult sexual risk behavior. However, delinquent behavior does not predict STI in a population-based sample of youth. Programs and interventions that address the sexual health of youth need to consider the role of delinquency in shaping sexual risk behaviors, and future research should explore broader societal and environmental risk factors on STIs.

Pubertal timing, friend smoking, and substance use in adolescent girls

The influence of friend substance use on the association between pubertal timing and substance use has received little consideration in the literature. With a sample of 264 female adolescents (11-17 years), this study examined (a) the relationship between pubertal timing and substance use, (b) the impact of number of friends that smoke cigarettes on adolescents' use of three substances (cigarettes, alcohol, and marijuana), and (c) the interactions between pubertal timing and friends' smoking in predicting individual substance use. Results showed a significant relationship between pubertal timing and alcohol use; later timing was related to more alcohol use. This association between late timing and alcohol use is contrary to previous literature and may be due to the broad age range of this sample. Pubertal timing may have less of an effect in late adolescence when drinking becomes more normative and less deviant; the rationale for this association is discussed. Second, this study found females who reported that more of their friends smoke regularly (at least once a week) used significantly more cigarettes, alcohol, and marijuana than those who reported no friends who smoke. Finally, the interaction between pubertal timing and number of friends who were regular smokers was not significantly related to adolescent substance use. However, friend smoking explained more of the variation in substance use than pubertal timing. This indicates that having friends who smoke is more influential in predicting substance use than pubertal timing. These findings are important when considering the development of interventions to target adolescent substance use.

Relationships between Social Information Processing and Aggression among Adolescent Girls with and without ADHD

This study investigated the relationship between social information processing and both relational and physical aggression in a longitudinally-followed sample of 228 adolescent girls (ages 11-18; 140 with ADHD and 88 comparison girls). During childhood, girls participated in naturalistic summer camps where peer rejection, overt physical aggression, and relational aggression were assessed via multiple informants and methods. Approximately 4.5 years later, these girls participated in follow-up assessments during which they completed a commonly-used vignette procedure to assess social information processing; overt and relational aggression were again assessed through multiple informants. Correlations between (a) overt and relational aggression and (b) maladaptive social information processing were modest in this female adolescent sample. However, relationships between aggression and social information processing were stronger for the comparison girls than for the girls with ADHD. The relevance of social information processing models for adolescent girls and clinical implications of findings are discussed.

Predictors, clinical characteristics, and outcome of conduct disorder in girls with attention-deficit/hyperactivity disorder: a longitudinal study

BACKGROUND

Research on the overlap between attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) in males has provided useful information on the etiology, correlates, course, and nosology of this co-morbid condition. However, it is unclear how these results extend to females. Our aim was to examine the predictors, clinical characteristics, and functional outcome of CD in a sample of female youth with and without ADHD.

METHOD

We conducted a blind, 5-year prospective longitudinal study of girls with (n=140) and without (n=122) ADHD, aged 6-18 years at baseline. At the 5-year follow-up, 123 (88%) and 112 (92%) of the ADHD and control children respectively were reassessed at a mean age of 16.7 years. Psychiatric disorders were assessed using blind structured diagnostic interviews.

RESULTS

Baseline ADHD was a significant risk factor for lifetime CD throughout childhood and adolescence [hazard ratio (HR) 5.8, 95% confidence interval (CI) 2.9-11.5, p<0.001]. Among ADHD girls, childhood-onset (<12 years) CD was predicted by paternal antisocial personality disorder (ASPD), while adolescent-onset CD (12 years) was predicted by family conflict. In addition, lifetime CD significantly predicted academic, psychiatric and sexual behavior problems in girls with ADHD at follow-up.

CONCLUSIONS

ADHD is a significant risk factor for CD in girls. CD is associated with increased risk for academic, psychiatric and sexual behavior problems compared to ADHD girls without CD. Given that the therapeutic approaches indicated by ADHD and CD differ, these findings highlight the importance of improved efforts aimed at early identification and treatment of CD in girls with ADHD.