Correlates of bullying and its relationship with psychiatric disorders in Lebanese adolescents

Prevalence and correlates of emotion dysregulation among children and adolescents in Lebanon: results from a National Survey

BACKGROUND

Data on Emotion Dysregulation among youth in Lebanon is scarce. Given that Emotion Dysregulation is associated with psychopathology and has a negative impact on youth outcomes, there is a need to better understand the prevalence, clinical and demographic correlates of Emotion Dysregulation.

METHODS

This study is a secondary analysis of the Psychopathology in Children and Adolescents in Lebanon Study which recruited 1517 youth and one parent from a nationally representative sample. Participants completed The Screen for Child Anxiety Related Emotional Disorders, Mood and Feelings Questionnaire, Strengths and Difficulties Questionnaire, Peer Relations Questionnaire, Conflict Behavior Questionnaire (CBQ).Parents completed a sociodemographic questionnaire and the General Health Questionnaire (GHQ). The Strengths and Difficulties Questionnaire-Dysregulation Profile was used to measure Emotion Dysregulation.

RESULTS

The prevalence of Emotion Dysregulation was 11.26% among children aged 5 to < 8 years, 9.40% among children aged 8 to < 12 years and 6.60% among those older than 12 years. Emotion Dysregulation was associated with psychopathology across age groups and a number of correlates were identified. In the final regression models, among children aged 5 to < 8 years; Emotion Dysregulation was associated with lower odds of father employment (OR = 0.235;CI[0.078,0.704]). For those aged 8 to < 12 years old, Emotion Dysregulation was associated with acceptable school performance (OR = 2.246,CI[1.209,4.173]) as opposed to a good school performance, having a chronic physical illness (OR = 2.962; CI [1.495,5.867)], and higher parental GHQ scores (OR = 1.034;CI [1.010,10.58)] indicating worse parental mental health. Adolescents aged 12 years and older who screened positive for Emotion Dysregulation were more likely to be younger (OR = 0.688, CI[0.527,0.899]), be a bully (OR = 2.467;CI[1.036,5.875] and to have higher parental CBQ scores (OR = 1.092;CI [1.011,1.180]), indicating worse parent-child conflict. Youth who screened positive for emotion dysregulation were more likely to seek psychiatric care than their counterparts who screen negative for emotion dysregulation.

CONCLUSION

Age, school performance, parental mental health, parental conflict, chronic physical illness and bullying emerge as important correlates of Emotion Dysregulation. Findings add to the limited data on Emotion Dysregulation in Lebanon and the region and are a first step towards developing intervention and prevention strategies.

Bullying Victimization of Children with Mental, Emotional, and Developmental or Behavioral (MEDB) Disorders in the United States

Though preventable, children with disabilities have a high risk of victimization, contributing to worsening health conditions. Hence, this study examined the exposure of school-age children with mental, emotional, developmental, or behavioral (MEDB) disorder to bully victimization. This study used the 2018 National Survey of Children's Health (NSCH) data of 23,494 children ages 5-17 to estimate multilevel logistic regression with fixed and random effects. Children's health conditions were treated as level one variables, while family poverty level and neighborhood characteristics such as vandalism and presence/absence of recreational centers were treated as level two variables. The paper presents the prevalence of bullying victimization among children with at least one disorder (MDBB = 39.5%), anxiety (20.6%), depression (10.8%), ADD/ADHD (18.3%), behavioral problems (14.9%), learning disability (11.9%), Tourette syndrome (0.5%), developmental delay (10.1%), Autism spectrum disorder (4.6%), speech disorder (10.7), and intellectual disability (1.6%), respectively. Bullying victimization was positively associated with anxiety (AOR = 1.995, 95% CI = 1.634-2.436), depression (AOR = 2.688, 95% CI = 2.031-3.557), developmental delay (AOR = 1.804, 95% CI = 1.422-2.288), but inversely associated with Autism spectrum disorder (AOR = 0.614, 95% CI = 0.399-0.946). Neighborhood disorganization and poverty were also associated with bullying victimization. The NSCH data suggests that children with disabilities in the US had a higher prevalence rate of victimization. Consequently, effective bullying prevention strategies that can protect and improve children's quality of life with special needs should be prioritized.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40653-021-00368-8.

Prevalence and associated factors of school bullying among Chinese college students in Changsha, China

BACKGROUND

School bullying has attracted worldwide attention for its adverse outcomes; however, there is still a lack of research among college students. The aim of this study was to investigate the prevalence of school bullying victimization and the associated factors among Chinese college students.

METHODS

8098 Chinese college students from two universities in Hunan province were recruited in this cross-sectional study, and data on participants' demographic information, bullying history, suicidal behaviors, anxiety (Self-Rating Anxiety Scale) and depression (Self-reporting Depression Scale) were collected. Binary logistic regression was used to analyze the independent correlates of school bullying.

RESULTS

The prevalence of school bullying was 8.03% in our study. Gender (OR,0.792;95%CI[0.660,0.950]; p = 0.012); depression (OR,1.979; 95%CI[1.359,2.883]; p < 0.001); anxiety (OR,1.996; 95%CI[1.388, 2.869]; p < 0.001); suicidal ideation (OR,1.353;95%CI[1.087,1.684]; p = 0.007); suicide attempts (OR,1.772;95%CI[1.306,2.403]; p < 0.001); family income between 30,000 and 70,000/year (yuan) (OR,0.763;95% CI[0.627,0.929]; p = 0.007) and family income more than 70,000/year (yuan) (OR,0.578;95%CI[0.461,0.725]; p < 0.001) were independent correlates of school bullying. The bullying score was positively correlated with physical or mental disorder history, family history of mental disorder, suicidal ideation, suicide plans, suicide attempts, anxiety, depression, smoking and drinking alcohol (all p < 0.05), and negatively correlated with right-handedness, good relationship with parents and family income (all p < 0.05).

LIMITATIONS

No causal relationship could be drawn due to the cross-sectional design.

CONCLUSION

School bullying is quite common among college students. In order to improve students' mental health and prevent suicide, we should pay attention to the negative effects of bullying victimization such as depression, anxiety, suicidal behaviors and so on, apart from putting in place anti-bullying interventions.

Psychopathology in Children and Adolescents in Lebanon Study (PALS): a national household survey

INTRODUCTION

Psychiatric disorders are among the leading causes of disability in children and adolescents globally. In Lebanon, a country that has endured a prolonged history of conflict and economic and political uncertainty, mental health surveys in children and adolescents have been limited to specific disorders or specific settings or cities. PALS (Psychopathology in Children and Adolescents in Lebanon Study) is the first study to screen a nationally representative sample of children and adolescents for psychiatric disorders and estimate the national prevalence of children and adolescents at risk of having a psychiatric disorder.

METHODS

A nationally representative household sample of 1517 children and adolescents (aged 5 years 0 months to 17 years 11 months) was recruited through a multi-stage stratified proportionate sampling technique between February 2018 and November 2018. Parents and adolescents completed a battery of self-reported scales including the Strengths and Feelings Questionnaire (SDQ), Mood and Feelings Questionnaire (MFQ), Screen for Child Anxiety and Emotional Related Disorders (SCARED), the Peer Relations Questionnaire (PRQ), General Health Questionnaire (GHQ), and Conflict Behavior Questionnaire (CBQ), Child Revised Impact of Events Scale (CRIES), and a demographic/clinical information questionnaire. Logistic regression models were used to examine the correlates of screening positive for psychiatric disorders.

RESULTS

About a third of children and adolescents (32.7%, n = 497) screened positive for at least one psychiatric disorder, of whom only 5% (n = 25) reported ever seeking professional mental health help. Academic performance, having a chronic physical illness, higher parental GHQ scores, and involvement in bullying were associated with a higher odds of screening positive for a psychiatric disorder. Higher family income was negatively associated with screening positive for a psychiatric disorder.

CONCLUSION

This first national study shows a high prevalence of psychiatric symptoms in Lebanese children and adolescents and an alarming treatment gap. School-based primary prevention programs or screening in primary care settings are key for early detection and management of psychiatric symptoms, and prevention of psychiatric disorders.

Home, school, and community violence exposure and emotional and conduct problems among low-income adolescents: the moderating role of age and sex

PURPOSE

The purpose of this study is to assess whether violence exposure is associated with emotional/conduct problems, when adjusting for confounders/covariates and controlling for comorbidity, and to investigate interactions between violence exposure and sex and/or age.

METHODS

This cross-sectional study evaluated a community-based sample of 669 in-school 11-15-year-olds. A three-stage probabilistic sampling plan included a random selection of census units, eligible households, and target child. Multivariable logistic regression investigated the effect of severe physical punishment by parents, peer victimization at school, and community violence on the study outcomes (adolescent-reported emotional/conduct problems identified by the Strengths and Difficulties Questionnaire/SDQ) when controlling for confounders (resilience, parental emotional warmth, maternal education/unemployment/anxiety/depression) and covariates (age, sex, stressful life events, parental rejection).

RESULTS

Considering interactions, emotional problems were associated with community violence victimization among girls, while conduct problems were associated with severe physical punishment among the younger, suffering peer aggression among the oldest, bullying victimization among girls, and witnessing community violence among boys. Desensitization (less emotional problems with greater violence exposure) was noted among the youngest exposed to severe physical punishment and the oldest who witnessed community violence.

CONCLUSION

Age and sex are moderators of the association between violence exposure and emotional/conduct problems. Interventions at local health units, schools, and communities could reduce the use of harsh physical punishment as a parental educational method, help adolescents deal with peer aggression at school and keep them out of the streets by increasing the usual five hours in school per day and making free sports and cultural/leisure activities available near their homes.

A cross-sectional study of COVID-19-related bullying in a sample of Lebanese adults: scale validation, correlates, and mediating effect of fear and anxiety

Background

The COVID-19 pandemic has led to prolonged exposure to stress and anxiety, raising concerns about a large spectrum of psychological side effects. The primary objective of the study was to validate the COVID-19 Bullying Scale (CBS-11). The second objective was to explore factors associated with COVID-19-related bullying and evaluate the mediating effect of fear and anxiety between knowledge and COVID-19-related bullying.

Methods

A cross-sectional online survey conducted between December 20, 2020, and January 5, 2021, recruited 405 Lebanese adults using a snowball sampling technique. The CBS-11, an 11-item tool specifically created for this study, was used to measure bullying behaviors towards COVID-19 patients.

Results

All items of the CBS-11 converged over a 1-factor solution with an eigenvalue over 1, accounting for a variance of 75.16%. The scale has a high Cronbach’s alpha (.974), indicating excellent reliability. A positive correlation was found between the COVID-19 bullying scale and fear, anxiety, and stigma discrimination. The logistic regression showed that higher fear of COVID-19 (ORa = 1.04), a positive attitude toward COVID-19 preventive measures and hygiene recommendations (ORa = 1.18), higher stigma discrimination scores (ORa = 1.09), and having a health professional family member (ORa = 2.42) were significantly associated with bullying.

Conclusion

Our main findings showed that the CBS-11 could be an efficient tool to measure bullying behaviors toward COVID-19 patients. Stigma discrimination and fear from COVID-19 were associated with higher bullying attitudes. Future prospective studies are needed to understand better the factors related to bullying among adults during a pandemic, such as COVID-19.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-021-00643-1.

Correlates of bullying perpetration among Lebanese adolescents: a national study

Background

Presently, 1 in 4 Lebanese adolescents is involved in bullying, with 12% being perpetrators. In Lebanon, around 90% of bullying incidents occur in schools. Given the lack of studies tackling bullying perpetration in Lebanon, this study aims to identify and target risk factors of bullying perpetration among Lebanese adolescents, which would serve future prevention and intervention programs.

Methods

This cross-sectional study took place between January and May 2019 in a proportionate random sample of schools from all Lebanese districts. A total of 1810 (90.5%) out of 2000 students accepted to participate.

Results

Results showed that 831 (49.1%, CI: 0.46–0.51) participants had bullied other people. A stepwise linear regression, using as the dependent variable the bullying perpetration score, showed that higher psychological (β = 0.12; 95% CI 0.083–0.176), sexual (β = 0.26; 95% CI 0.128–0.411), neglect (β = 0.08; 95% CI 0.051–0.120), physical abuse (β = 0.13; 95% CI 0.036–0.235), higher internet addiction (β = 0.07; 95% CI 0.057–0.097), higher social fear (β = 0.10; 95% CI 0.075–0.140), and having separated parents (β = 1.60; 95% CI 0.561–2.650) were significantly associated with more bullying perpetration. Higher social avoidance (β = − 0.03; 95% CI -0.062- -0.003) was significantly associated with less bullying perpetration.

Conclusion

The results revealed that bullying perpetration is significantly associated with parental status, child abuse, internet addiction, and social fear. Educational and relevant governmental institutions could use our findings to develop and implement efficient bullying prevention and intervention programs for all involved parties.

Different baseline physical activity predicts susceptibility and resilience to chronic social defeat stress in mice: Involvement of dopamine neurons

Physical inactivity, the fourth leading mortality risk factor worldwide, is associated with chronic mental illness. Identifying the mechanisms underlying different levels of baseline physical activity and the effects of these levels on the susceptibility to stress is very important. However, whether different levels of baseline physical activity influence the susceptibility and resilience to chronic social defeat stress (CSDS), and the underlying mechanisms in the brain remain unclear. The present study segregated wild-type mice into low baseline physical activity (LBPA) and high baseline physical activity (HBPA) groups based on short term voluntary wheel running (VWR). LBPA mice showed obvious susceptibility to CSDS, while HBPA mice were resilient to CSDS. In addition, the expression of tyrosine hydroxylase (TH) in the ventral tegmental area (VTA) was lower in LBPA mice than in HBPA mice. Furthermore, activation of TH neurons in the VTA of LBPA mice by chemogenetic methods increased the levels of VWR and resilience to CSDS. In contrast, inhibiting TH neurons in the VTA of HBPA mice lowered the levels of VWR and increased their susceptibility to CSDS. Thus, this study suggests that different baseline physical activities might be mediated by the dopamine system. This system also affects the susceptibility and resilience to CSDS, possibly via alteration of the baseline physical activity. This perspective on the neural control and impacts on VWR may aid the development of strategies to motivate and sustain voluntary physical activity. Furthermore, this can maximize the impacts of regular physical activity toward stress-reduction and health promotion.

What do we Know about Bullying in Syrian Adolescent Refugees? A Cross Sectional Study from Turkey : (Bullying in Syrian Adolescent Refugees)

The aim of this study was to assess the bullying status of Syrian adolescent refugees in Turkey and identify factors that contribute to bullying. The adolescents aged between 12 and 16 years and who live in Kilis as a Syrian refugee assessed between the dates 01.01.2019-01.01.2020. Currently, 119 children and adolescents were enrolled in the study. Kiddie-Schedule for Affective Disorders and Schizophrenia (present and life time version - K-SADS-PL) was applied by a specialist of child and adolescent psychiatry. The Sociodemographic Data Form, The Strengths and Difficulties Questionnaire (SDQ) and Olweus Bully/Victim Questionnaire (OBVQ) were used for assesment of children and adolescents. Of the study sample, 31 adolescents (27.1%) were diagnosed with at least one psychiatric disorder. The most prevalent psychiatric disorder was Other Specified Trauma and Stressor Related disorder (13.4%) and Post- traumatic stres disorder (6.7%). The prevalence of bullying and victimization was found as 58.9%. The boys group was significantly more likely to be bully and both victim and bully (p = 0.04, p = 0.001* respectively) compared to the girls group. Our results demonstrate that besides the past experiences related to war and immigration, the adolescent refugees experienced bullying consequences of being a refugee in Turkey.

Bullying victimization among Lebanese adolescents: The role of child abuse, Internet addiction, social phobia and depression and validation of the Illinois Bully Scale

Background

Both bullying victimization and perpetration were associated with depression, social phobia, physical and psychological child abuse and Internet addiction in Lebanon. The prevalence of bullying in Lebanon is alarming, with 50% of school-aged children and adolescents reporting being bullied at some point. The high rate of both bullying victimization can be reflective of the inefficacy of current prevention and intervention policies in targeting associated problematic individual and contextual factors. The objective of the present study was to analyze factors associated with bullying victimization and validate the Illinois Bully Scale among Lebanese adolescents.

Methods

This is cross-sectional study that took place between January and May 2019. We enrolled 1810 adolescents between 14 and 17 years of age. The Illinois Bully scale was used to measure bullying victimization. In order to ensure the adequacy of the sample with values greater than 0.8 - an indicator that component or factor analysis was useful for these variables - we used Kaiser-Meyer-Olkin (KMO) measurement. Statistical significance considered if the p-value < 0.05.

Results

The results showed that 841 (46.5%, CI: 44.1% – 48.7%) participants were classified as having been previously bullied. None of the bullying scale items was removed. Items on the bullying scale converged on a two-factor solution with Eigenvalues greater than 1, accounting for a total of 73.63% of the variance (Factor 1: bullying victimization; Factor 2: bullying perpetration; KMO = 0.899, Bartlett’s sphericity test p < 0.001; αCronbach = 0.955). Having a separate parents (ORa = 3.08), Mild (ORa-4.71) to moderate (ORa = 3.84) internet addiction test, higher social fear (ORa = 1.50), higher psychological abuse (ORa = 3.59), higher child neglect (ORa = 2.21) and physical (ORa = 4.55) abuse were significantly associated with higher odds of being bullied. However, higher social avoidance (ORa = 0.49), poor (ORa = 0.20), fair (ORa = 0.94) and very good (ORa = 0.04) physical activity as compared to sedentary were significantly associated with lower odds of being bullied.

Conclusions

Our findings attest that bullying victimization is likely to be associated with certain factors such as child abuse of all forms, Internet addiction, social fear and avoidance. In addition, the Illinois Bully Scale was validated in Lebanon. More attention should be paid to students vulnerable to bullying victimization, such as those with environmental or domestic problems, and adolescents with psychological disorders such as behavioral addictions.

Disruptive Behavior Programs on Primary School Students: A Systematic Review

The objective of this study was to review the existing international literature on research and programs for the reduction of disruptive behavior in primary school students. For this purpose, according to PRISMA-ScR, a mixed systematic review was performed in six databases in order to obtain wide and extensive information related to the subject under study. The studies obtained were analyzed through a table which emphasized the data related to: Author(s), year, educational stage, location, objectives, instruments, and results. As for the selection of studies, the UNESCO Thesaurus and the ERIC Thesaurus terminology was used. In addition to specifying the search for studies performed between 2004 and 2020 (both inclusive), articles written in Spanish and English were selected. Furthermore, in a final phase among the articles analyzed, those that were not or did not contain intervention programs were discarded. Therefore, a total of thirty-five articles out of more than twenty thousand were analyzed in depth. The results showed that a majority of programs were implemented in the primary education stage, as well as a predominance of the use of instruments, such as questionnaires and observation charts. In addition, it is important to underline that 77.14% of the programs analyzed were effective, hence, they met the proposed objectives. In summary, although the number of intervention programs for the reduction of disruptive behavior that can be found in the international scientific literature is growing, there is still a long way to go in order to create a large network that can serve as a foundation for interventions in primary education students.

Trends of Alcohol Use, Dietary Behaviour, Interpersonal Violence, Mental Health, Oral and Hand Hygiene Behaviour among Adolescents in Lebanon: Cross-Sectional National School Surveys from 2005, 2011 and 2017

Health risk behaviours during adolescence can have long-term negative consequences. Little is known, however, about the recent health risk behaviour trends in adolescents in Lebanon. This investigation aimed to report the trends in the prevalence of various health risk behaviours, such as alcohol use, dietary behaviour, interpersonal violence, mental health, oral and hand hygiene, among adolescents in Lebanon. Cross-sectional nationally representative data were analysed from 13,109 adolescents (14 years median age) that participated in three waves (2005, 2011 and 2017) of the “Lebanon Global School-Based Student Health Survey (GSHS)”. Results indicate that significant improvements were found among both boys and girls in the decline in interpersonal violence (bulling victimization, being physically attack and involvement in physical fighting), poor washing of hands after using the toilet, and suicide planning, and among girls only loneliness, worry-induced sleep disturbance and suicidal ideation. Significant increases were found among both boys and girls in the prevalence of inadequate fruit consumption, and among boys only unintentional injury and not always washing hands before eating. In conclusion, several decreases but also increases in health risk behaviours were found over three assessment points during a period of 12 years calling for continued health enhancing activities in this adolescent population.

Cybervictimization, Self-Concept, Aggressiveness, and School Anxiety in School Children: A Structural Equations Analysis

The rapid increase in cases of cybervictimization amongst children has led researchers to examine the psychoemotional factors related to cyberbullying behavior, in an attempt to prevent and minimize its impact. The objective of this study was to establish and contrast the fit of an explanatory model on cybervictimization based on its relationship with self-concept, aggressiveness, and school anxiety using a structural equations analysis. A total of 542 Spanish students aged 10-12 (M age = 10.97; SD = 0.74) completed a battery of questionnaires. An adjusted structural equations model was obtained (χ² = 512.23; df = 99; p < 0.001; CFI = 0.928; NFI = 0.91; IFI = 0.928; RMSEA = 0.078). A direct and negative relationship was obtained between cybervictimization and self-concept and between cybervictimization and school anxiety. In addition, a direct and positive relationship was found between aggressiveness and self-concept and between aggressiveness and school anxiety. Indirect relationships were not found between the variables. The study's findings demonstrate that the variables of self-concept and school anxiety are directly related to cybervictimization and that the improved psychoemotional adjustment of the youngest students may help to prevent the risk of being victimized over the Internet.

Being Bullied Is Associated With Depression Among Malaysian Adolescents: Findings From a Cross-Sectional Study in Malaysia

Limited evidence on the association of being bullied with depression among adolescents was found in Malaysia. This study aimed to determine the association of being bullied and depression among Malaysian school-going adolescents. Data from the National Health and Morbidity Survey 2017, a cross-sectional study conducted from March to May 2017, was analyzed using descriptive and multiple logistic regression analysis. A validated tool, the Depression, Anxiety, and Stress Scale-21 was used to categorize those with moderate or higher levels of depressive symptoms as having depression. A total of 27 399 school-going adolescents participated and 18.3% were found depressed. Adolescents of Indian ethnicity (adjusted odds ratio [aOR] = 2.02, P < .001), those with parents living apart (aOR = 1.41, P < .001), and those who were being bullied (aOR = 2.98, P < .001) were more likely to have depression. This study demonstrated the association between being bullied and having depression. Comprehensive preventive strategies should be implemented taking into consideration the findings from this study.

Suicidality among Lebanese adolescents: Prevalence, predictors and service utilization

Suicide and self-harm in young people is a global public health issue, although epidemiological evidence remains scant in many parts of the world. The aims of the present study are to describe the prevalence, comorbidity patterns, and the clinical and demographic correlates of suicidality among a representative sample of adolescents from Beirut, Lebanon. We recruited 510 adolescents aged 11-17 and one of their parents/legal guardians using a multistage random cluster design. The validated Arabic version of the Development and Well-Being Assessment (DAWBA) was administered independently to the parent/legal guardian, and adolescents, who also self-completed the Strengths and Difficulties Questionnaire (SDQ), and the Peer-Relations Questionnaire (PRQ). The parent/legal guardian also completed the SDQ and provided demographic and clinical information. A total of 22 adolescents (4.3%) have experienced suicidal ideation or attempt. Correlates of suicidality were female gender, alcohol use in the past 4 weeks, lifetime exposure to a stressful life event, suffering from a major depressive disorder and having bipolar disorder within the last 4 weeks. Only 1 suicidal participant reported ever seeking professional mental health help. Our findings highlight an alarming treatment gap in Lebanese adolescents experiencing suicidality. Future studies should aim at investigating barriers to care and at developing community-based interventions to improve access to care.

Voluntary Wheel Running Reverses Deficits in Social Behavior Induced by Chronic Social Defeat Stress in Mice: Involvement of the Dopamine System

Voluntary exercise has been reported to have a therapeutic effect on many psychiatric disorders and social stress is known to impair social interaction. However, whether voluntary exercise could reverse deficits in social behaviors induced by chronic social defeat stress (CSDS) and the underlying mechanism remain unclear. The present study shows CSDS impaired social preference and induced social interaction deficiency in susceptible mice. Voluntary wheel running (VWR) reversed these effects. In addition, CSDS decreased the levels of tyrosine hydroxylase in the ventral tegmental area and the D2 receptor (D2R) in the nucleus accumbens (NAc) shell. These changes can be recovered by VWR. Furthermore, the recovery effect of VWR on deficits in social behaviors in CSDS mice was blocked by the microinjection of D2R antagonist raclopride into the NAc shell. Thus, these results suggest that the mechanism underlying CSDS-induced social interaction disorder might be caused by an alteration of the dopamine system. VWR may be a novel means to treat CSDS-induced deficits in social behaviors via modifying the dopamine system.