The neurobiology of oppositional defiant disorder and conduct disorder: altered functioning in three mental domains

Measuring Children's Reward and Punishment Sensitivity: An Initial Psychometric Evaluation of the Contingency Response Rating Scale

Existing research shows that children's responses to rewards and punishments are essential for understanding attention-deficit/hyperactivity disorder, oppositional defiant disorder, conduct disorder, and callous-unemotional traits. The present study developed the Contingency Response Rating Scale (CRRS) to fulfill the need for a reliable and valid measure of children's contingency response style that is brief, easy to use in applied settings, and provides additional information to existing clinical measures. We examined the psychometric properties of the CRRS in a sample of 196 children (ages 5-12), most of whom were referred to evaluate attention and behavior problems in an outpatient clinic. Using principal axis factoring, we identified five factors: (a) punishment ineffectiveness, (b) reward ineffectiveness, (c) punishment dysregulation, (d) reward dysregulation, and (e) contingency insensitivity. The subscales based on these factors showed acceptable test-retest and internal consistency reliability, and scale intercorrelations varied from low to moderate. The subscales also captured significant variance not explained by child or parent demographics and were associated with measures of psychopathology and impairment. The results provide preliminary evidence that the CRRS may be a helpful tool for assessing reward and punishment sensitivity in children with attention and behavior problems.

Involving Parents in Cognitive Behavioral Therapy for Children and Adolescents with Conduct Problems: Goals, Outcome Expectations, and Normative Beliefs About Aggression are Targeted in Sessions with Parents and Their Child

Children and adolescents with conduct problems participate in Cognitive Behavioral Therapy (CBT), either in individual or group format, in view of learning social problem-solving skills that enable them to behave in more independent and situation-appropriate ways. Parents must support their child's learning processes in everyday life and therefore these processes need attention in CBT sessions in which parents and their child participate. The social problem-solving model of CBT previously described (Matthys & Schutter, Clin Child Fam Psychol Rev 25:552-572, 2022; Matthys & Schutter, Clin Child Fam Psychol Rev 26:401-415, 2023) consists of nine psychological skills. In this narrative review we propose that instead of addressing each skill separately in sessions with both parents and their child, therapists work on three schemas (latent mental structures): (1) goals, (2) outcome expectations, and (3) normative beliefs about aggression. Based on social-cognitive and cognitive neuroscience studies we argue that these three schemas affect five core social problem-solving skills: (1) interpretation, (2) clarification of goals, (3) generations of solutions, (4) evaluation of solutions, and (5) decision-making. In view of tailoring CBT to the individual child's characteristic schemas and associated social problem-solving skills, we suggest that children and adolescents participate in individual sessions with their parents. The therapist uses Socratic questioning in order to find out characteristic schemas of the child, encourage reflection on these schemas, and explore alternative schemas that had previously been outside the child's attention. The therapist functions as a model for parents to ask their child questions about the relevant schemas with a view of achieving changes in the schemas.

A critical review of hot executive functioning in youth attention-deficit/hyperactivity disorder: Methodological limitations, conceptual considerations, and future directions

Hot executive functioning (EF) - EF under emotionally or motivationally salient conditions - is a putative etiology of attention-deficit/hyperactivity disorder (ADHD), disruptive behavior problems (DBPs), and their related impairments. Despite two decades of research, the present study is the first review of the construct in youth ADHD, with a particular focus on the role of task design, age, and DBPs, as well as relevant conceptual and methodological considerations. While certain hot EF tasks have been investigated extensively (e.g., choice impulsivity), substantial inconsistency in measurement of the broader construct remains, severely limiting conclusions. Future research should a) consider the extent to which various hot EF tasks relate to one another, a higher order factor, and other related constructs; b) further investigate task design, particularly the elicitation of emotion or motivation and its anticipated effect on EF; and c) incorporate multiple levels of analysis to validate similarities and differences among tasks with regard to the affective experiences and cognitive demands they elicit. With improved measurement and conceptual clarity, hot EF has potential to advance the literature on etiological pathways to ADHD, DBPs and associated impairments and, more broadly, may represent a useful tool for understanding the influence of emotion and motivation on cognition.

Subjective and Autonomic Arousal toward Emotional Stimuli in Preadolescents with Externalizing Problems and the Role of Explicit and Implicit Emotion Regulation

Children and adolescents with externalizing problems show physiological hypo-reactivity toward affective stimuli, which may relate to their disruptive, antisocial, and thrill-seeking behaviors. This study examines differences in explicit and implicit emotion regulation between preadolescents with and without externalizing problems as well as the role of emotion regulation in subjective and autonomic responses to emotional stimuli. Preadolescents showing self- and other-reported externalizing psychopathology, and a control sample, without such difficulties, participated in a passive affective picture-viewing task with neutral, fearful, joyful, and sad images, while their heart rate and heart rate variability were measured. Participants also reported on their emotion regulation difficulties using the Difficulties in Emotion Regulation Scale. Compared to controls, youths scoring high on externalizing problems (1) reported greater emotion regulation difficulties, especially a lack of emotional clarity and difficulty in controlling impulsive actions, (2) showed higher resting heart rate variability and a lower resting heart rate, suggestive of higher emotion/autonomic regulation ability, and (3) showed both subjective and physiological hypo-arousal to emotional pictures. Heart rate variability and, to a lesser degree difficulties in emotional clarity, modulated the effects of emotional pictures on subjective and physiological arousal. Findings suggest that interventions to improve emotion regulation and awareness may help to prevent externalizing problems.

Predictors and Correlates of Positive Urine Drug Screening in a Retrospective Cohort Analysis of Child and Adolescent Psychiatry Inpatients Throughout the COVID-19 Pandemic

BACKGROUND AND OBJECTIVES

Youth substance use is associated with significant psychological, neurological, and medical complications. Risk factors for substance use among children and adolescents in the general population include peer and/or parental substance use, certain psychiatric illnesses (eg, Attention-Deficit/Hyperactivity Disorder, depression), and history of maltreatment. Co-occurring substance use and psychiatric illness have been associated with increased suicidality, but few prior studies have characterized substance use among child/adolescent inpatients. As such, it remains unclear how substance use contributing to acute psychiatric presentations has changed since the start of the COVID-19 pandemic.

METHODS

This is a retrospective cohort study of 816 unique child/adolescent psychiatry inpatients with urine drug screening (UDS) results from a diverse urban setting. Charts of patients hospitalized between June 1, 2018 and November 30, 2021 were reviewed for sociodemographic characteristics, indication for admission, psychiatric history, hospital course, treatment plan, and discharge diagnosis. Differences in sociodemographic and clinical characteristics, such as age, race, and diagnoses, between patients with and without positive UDS were explored throughout various periods of the COVID-19 pandemic. Descriptive and comparative statistics were performed, as well as a logistic regression model to identify the predictors of positive UDS.

RESULTS

Of the study sample, 18% had a positive UDS. Older age, diagnosis of impulsive or behavioral disorder, and a history of violence were found to be predictors of positive UDS. Asian/South Asian or Hispanic/LatinX race and history of a developmental or intellectual disability were found to be negative predictors. The frequency of positive UDS in this population did not change based on COVID-19.

DISCUSSION AND CONCLUSIONS

Multiple factors may predispose children and adolescents to substance use. Though no impact of COVID-19 was found in this sample, longer-term studies are needed.

SCIENTIFIC SIGNIFICANCE

This study identifies independent predictors of active substance use in the child and adolescent psychiatric inpatient population.

Caffeinated Soda Intake in Children Is Associated with Neurobehavioral Risk Factors for Substance Misuse

BACKGROUND AND OBJECTIVES

Use of psychotropic substances in childhood has been associated with both impulsivity and other manifestations of poor executive function as well as escalation over time to use of progressively stronger substances. However, how this relationship may start in earlier childhood has not been well explored. Here, we investigated the neurobehavioral correlates of daily caffeinated soda consumption in preadolescent children and examined whether caffeinated soda intake is associated with a higher risk of subsequent alcohol initiation.

METHODS

Using Adolescent Brain Cognitive Development study data (N = 2,092), we first investigated cross-sectional relationships between frequent caffeinated soda intake and well-known risk factors of substance misuse: impaired working memory, high impulsivity, and aberrant reward processing. We then examined whether caffeinated soda intake at baseline predicts more alcohol sipping at 12 months follow-up using a machine learning algorithm.

RESULTS

Daily consumption of caffeinated soda was cross-sectionally associated with neurobehavioral risk factors for substance misuse such as higher impulsivity scores and lower working memory performance. Furthermore, caffeinated soda intake predicted a 2.04 times greater likelihood of alcohol sipping after 12 months, even after controlling for rates of baseline alcohol sipping rates.

CONCLUSIONS

These findings suggest that previous linkages between caffeine and substance use in adolescence also extend to younger initiation, and may stem from core neurocognitive features thought conducive to substance initiation.

Detecting social information processing profiles of boys with aggressive behavior problems: An interactive virtual reality approach

Children with aggressive behavior problems may aggress for different reasons, requiring tailored assessment and treatment. The aim of this study was to test whether it is possible to detect distinct social information processing (SIP) profiles among boys with aggressive behavior problems. We therefore conducted Latent Profile Analyses on boys' SIP patterns assessed in interactive virtual reality. Additionally, we examined the discriminant validity of these SIP profiles by comparing them on theoretically relevant child characteristics (i.e., temperament, executive functioning, aggressive belief systems, punishment insensitivity, sensation seeking). We presented boys (N = 181; ages 7-13) with a virtual classroom where they could play games with virtual peers. They reported on their SIP in four virtual reality scenarios, designed to assess reactive and proactive aggressive SIP. Results revealed four distinct SIP profiles: a general reactive SIP profile, a situation-specific reactive SIP profile, a mixed reactive-proactive SIP profile, and a nonaggressive SIP profile. Planned contrasts revealed that boys with these SIP profiles differed in temperament, aggressive belief systems, and punishment insensitivity, but not in executive functioning and sensation seeking. Overall, findings suggest that boys differ in the exact SIP patterns underlying their aggressive behavior, providing inroads to tailor interventions to children's individual needs.

Action initiation and punishment learning differ from childhood to adolescence while reward learning remains stable

Theoretical and empirical accounts suggest that adolescence is associated with heightened reward learning and impulsivity. Experimental tasks and computational models that can dissociate reward learning from the tendency to initiate actions impulsively (action initiation bias) are thus critical to characterise the mechanisms that drive developmental differences. However, existing work has rarely quantified both learning ability and action initiation, or it has relied on small samples. Here, using computational modelling of a learning task collected from a large sample (N = 742, 9-18 years, 11 countries), we test differences in reward and punishment learning and action initiation from childhood to adolescence. Computational modelling reveals that whilst punishment learning rates increase with age, reward learning remains stable. In parallel, action initiation biases decrease with age. Results are similar when considering pubertal stage instead of chronological age. We conclude that heightened reward responsivity in adolescence can reflect differences in action initiation rather than enhanced reward learning.

Differential processing of risk and reward in delinquent and non-delinquent youth

The present study examined the behavioral and neural differences in risky decision-making between delinquent (n = 23) and non-delinquent (n = 27) youth ages 13-17 years (M = 16, SD = 0.97) in relation to reward processing. While undergoing functional neuroimaging, participants completed an experimental risk task wherein they received feedback about the riskiness of their behavior in the form of facial expressions that morphed from happy to angry. Behavioral results indicated that delinquent youth took fewer risks and earned fewer rewards on the task than non-delinquent youth. Results from whole-brain analyses indicated no group differences in sensitivity to punishments (i.e. angry faces), but instead showed that delinquent youth evinced greater neural tracking of reward outcomes (i.e. cash-ins) in regions including the ventral striatum and inferior frontal gyrus. While behavioral results show that delinquent youth were more risk-averse, the neural results indicated that delinquent youth were also more reward-driven, potentially suggesting a preference for immediate rewards. Results offer important insights into differential decision-making processes between delinquent and non-delinquent youth.

Exploring the interplay of dopaminergic genotype and parental behavior in relation to executive function in early childhood

Child genotype is an important biologically based individual difference conferring differential sensitivity to the effect of parental behavior. This study explored dopaminergic polygenic composite × parental behavior interactions in relation to young children's executive function. Participants were 135 36-month-old children and their mothers drawn from a prospective cohort followed longitudinally from pregnancy. A polygenic composite was created based on the number of COMT, DAT1, DRD2, and DRD4 alleles associated with increased reward sensitivity children carried. Maternal negative reactivity and responsiveness were coded during a series of structured mother-child interactions. Executive function was operationalized as self-control and working memory/inhibitory control. Path analysis supported a polygenic composite by negative reactivity interaction for self-control. The nature of the interaction was one of diathesis-stress, such that higher negative reactivity was associated with poorer self-control for children with higher polygenic composite scores. This result suggests that children with a higher number of alleles may be more vulnerable to the negative effect of negative reactivity. Negative reactivity may increase the risk for developing behavior problems in this population via an association with poorer self-control. Due to the small sample size, these initial findings should be treated with caution until they are replicated in a larger independent sample.

Resting heart rate and antisocial behaviour: a Mendelian randomisation study

Observational studies frequently report phenotypic associations between low resting heart rate (RHR) and higher levels of antisocial behaviour (ASB), although it remains unclear whether this relationship reflects causality. To triangulate evidence, we conducted two-sample univariable Mendelian randomisation (MR), multivariable MR and linkage disequilibrium score regression (LDSC) analyses. Genetic data were accessed from published genome-wide association studies (GWAS) for RHR (n = 458,835) and ASB (n = 85,359) for the univariable analyses, along with a third GWAS for heart rate variability (HRV; n = 53,174) for all other analyses. Genome-wide significant (p < 5 × 10-8) single-nucleotide polymorphisms associated with RHR (n = 278) were selected as instrumental variables and the outcome was a composite measure of ASB. No causal association was observed between RHR and ASB (BIVW =  - 0.0004, p = 0.841). The multivariable MR analyses including RHR and HRV also suggested no causal associations (BIVW = 0.016, p = 0.914) and no genetic correlations between the heart rate measures and ASB were observed using LDSC (rg = 0.057, p = 0.169). Sensitivity analyses suggested that our results are not likely to be affected by heterogeneity, pleiotropic effects, or reverse causation. These findings suggest that individual differences in autonomic nervous system functioning indexed by RHR are not likely to directly contribute to the development of ASB. Therefore, previously observed associations between RHR and ASB may arise from confounding, reverse causation, and/or additional study characteristics. Further causally informative longitudinal research is required to confirm our findings, and caution should be applied when using measures of RHR in interventions targeting ASB.

Oppositional defiant disorder

Oppositional defiant disorder (ODD) is a disruptive behaviour disorder involving an ongoing pattern of angry/irritable mood, argumentative/defiant behaviour and vindictiveness. Onset is typically before 8 years of age, although ODD can be diagnosed in both children and adults. This disorder is associated with substantial social and economic burden, and childhood ODD is one of the most common precursors of other mental health problems that can arise across the lifespan. The population prevalence of ODD is ~3 to 5%. A higher prevalence in males than females has been reported, particularly before adolescence. No single risk factor accounts for ODD. The development of this disorder seems to arise from the interaction of genetic and environmental factors, and mechanisms embedded in social relationships are understood to contribute to its maintenance. The treatment of ODD is often successful, and relatively brief parenting interventions produce large sized treatment effects in early childhood. Accordingly, ODD represents an important focus for research, practice and policy concerning early intervention and prevention in mental health.

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.

The bidirectional relationship between sleep and externalizing behavior: A systematic review

It is well-established that sleep and behavior are interrelated. Although studies have investigated this association, not many have evaluated the bidirectional relationship between the two. To our knowledge this is the first systematic review providing a comprehensive analysis of a reciprocal relationship between sleep and externalizing behavior. Five databases (PsycINFO, PubMed, Web of Science, Scopus, and Google Scholar) were utilized to yield a total of 3,762 studies of which 20 eligible studies, empirical articles examining bidirectionality of sleep and externalizing behavior, were selected for analysis. According to the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis, the varying methodological approaches used in these studies were analyzed and synthesized, including examining differences and similarities in outcomes between distinct study designs (longitudinal vs cross-sectional), sleep measures (objective vs subjective vs a combination of both), informants (parents, self-report, teachers), and recruited participants (clinical, subclinical and typical populations). The assessment of risk of bias and quality of studies was guided by the instruments employed in research on sleep and behavior in the past. This review establishes that a bidirectional relationship between sleep problems and externalizing behavior clearly exists, and identifies limitations in the existing literature. Furthermore, the importance of early interventions that target both externalizing behaviors and sleep problems is highlighted as a potentially effective way of breaking the sleep-externalizing behavior relationship. Nonetheless, causality cannot be claimed until more trials that manipulate sleep and evaluate changes in externalizing behavior are conducted.

Differential associations of maternal behavior to preschool boys' and girls' executive function

Boys are more sensitive to environmental factors like parental behavior, an important predictor of executive function. This study examined whether the interaction between child sex and maternal behavior was associated with children's executive function in a manner consistent with the vulnerability or differential susceptibility model. Participants were 146 36-month-old children and their mothers. Maternal responsiveness and negative reactivity were coded during structured mother-child interactions. Executive function was operationalized as latent self-control and working memory/inhibitory control (WMIC). Structural equation modelling supported a sex by responsiveness interaction for self-control but not WMIC. Consistent with a vulnerability model, less responsiveness was associated with poorer self-control for boys relative to girls. Boys' self-control may be more vulnerable to the negative effect of unresponsive maternal behavior helping explain boys increased risk for externalizing behavior problems.

Loss and Frontal Striatal Reactivities Characterize Alcohol Use Severity and Rule-Breaking Behavior in Young Adult Drinkers

BACKGROUND

Alcohol misuse is associated with externalizing behaviors, including rule breaking. Studies have implicated altered reward processing in externalizing behaviors and alcohol misuse. Here, we investigated whether reward or punishment reactivity more significantly influenced alcohol use severity and rule-breaking behavior in young adult drinkers.

METHODS

We curated data from the Human Connectome Project and identified 181 binge (132 men) and 288 nonbinge (97 men) drinkers performing a gambling task during brain imaging. Alcohol use severity was quantified by the first principal component of principal-component analysis of all drinking measures. We analyzed the imaging data using published routines and evaluated the results at a corrected threshold. We examined the interrelationship between imaging and clinical metrics with mediation and path analyses.

RESULTS

Compared with nonbingers, bingers showed more severe rule-breaking behavior and responded significantly faster during post-loss than during post-win trials. Compared with nonbingers, bingers demonstrated greater inferior/middle frontal gyrus and cerebellum activations in loss-predominating blocks but no differences in regional responses to win-predominating blocks, relative to an interblock baseline. The right caudate body showed loss reactivity that was positively correlated with the rule-breaking score. No regional responses to wins were significantly correlated with the rule-breaking score. Mediation and path analyses demonstrated significant models with inferior/middle frontal gyrus and caudate reactivity to loss interrelating rule breaking and alcohol use severity.

CONCLUSIONS

Punishment rather than reward reactivity was associated with alcohol use severity and rule breaking in young adults. The findings highlight the roles of negative emotions in psychological models of externalizing behaviors and alcohol misuse.

Reciprocal relations between dimensions of Oppositional defiant problems and callous-unemotional traits

Although irritability, headstrong/defiant behavior, and callous-unemotional traits (CU traits) often co-occur, the prospective associations between them are not well known. A general population sample of 622 children was followed up yearly from ages 3 to 12 years and assessed using dimensional measures of irritability, headstrong/defiant, and CU traits with teacher provided information. A random intercept cross-lagged panel model, accounting for all unmeasured time-invariant confounding using the children as their own controls, revealed cross-lagged reciprocal associations between increased headstrong/defiant and increased CU traits at all ages and a unidirectional association from headstrong/defiant to irritability. The findings are consistent with headstrong/defiant behavior and CU traits mutually influencing each other over time and headstrong/defiant behavior enhancing irritability. School-based intervention and prevention programs should take these findings into consideration. They also suggest that irritability acts as a distinct developmental dimension of headstrong/defiant and callous-unemotional behaviors and needs to be addressed independently.

Raging Hormones: Why Age-Based Etiological Conceptualizations of the Development of Antisocial Behavior Are Insufficient

Developmental science, particularly developmental neuroscience, has substantially influenced the modern legal system. However, this science has typically failed to consider the role of puberty and pubertal hormones on development when considering antisocial behavior. This review describes major theoretical positions on the developmental neuroscience of antisocial behavior and highlights where basic developmental neuroscience suggests that the role of puberty and pubertal hormones should be considered. The implications of the current state of the science with respect to developmental neuroscience is considered, particularly what is known in light of development beyond puberty. This review shows that development continues to an older age for many youth than the legal system typically acknowledges. The plasticity of the brain that this continued development implies has implications for the outcome of interventions in the legal system in ways that have not been explored. Future directions for both developmental scientists and legal professions are recommended.

Altered reward and effort processing in children with maltreatment experience: a potential indicator of mental health vulnerability

In this longitudinal study of children and adolescents with a documented history of maltreatment, we investigated the impact of maltreatment on behavioral and neural indices of effort-based decision making for reward and examined their associations with future internalizing symptoms. Thirty-seven children with a documented history of maltreatment (MT group) and a carefully matched group of 33 non-maltreated children (NMT group) aged 10-16, completed an effort-based decision-making task during functional magnetic resonance imaging (fMRI). Internalizing symptoms were assessed at baseline and again 18 months later. Computational models were implemented to extract individual estimates of reward and effort sensitivity, and neural signals during decision-making about different levels of reward and effort were analyzed. These were used to predict internalizing symptoms at follow-up. We identified lower effort-related activation in the anterior cingulate cortex (ACC), a prespecified region-of-interest, in the MT relative to the NMT group. No group differences were observed in the striatum, or in behavioral indices of reward and effort processing. Lower effort-related ACC activation significantly predicted elevated internalizing symptoms at follow-up in the MT group. These findings suggest that disrupted effort-related activation may index latent vulnerability to mental illness in children who have experienced maltreatment.

Improving Our Understanding of Impaired Social Problem-Solving in Children and Adolescents with Conduct Problems: Implications for Cognitive Behavioral Therapy

In cognitive behavioral therapy (CBT) children and adolescents with conduct problems learn social problem-solving skills that enable them to behave in more independent and situation appropriate ways. Empirical studies on psychological functions show that the effectiveness of CBT may be further improved by putting more emphasis on (1) recognition of the type of social situations that are problematic, (2) recognition of facial expressions in view of initiating social problem-solving, (3) effortful emotion regulation and emotion awareness, (4) behavioral inhibition and working memory, (5) interpretation of the social problem, (6) affective empathy, (7) generation of appropriate solutions, (8) outcome expectations and moral beliefs, and (9) decision-making. To improve effectiveness, CBT could be tailored to the individual child's or adolescent's impairments of these psychological functions which may depend on the type of conduct problems and their associated problems.

Neuropsychological Characterization of Aggressive Behavior in Children and Adolescents with CD/ODD and Effects of Single Doses of Medications: The Protocol of the Matrics_WP6-1 Study

Aggressive behaviors and disruptive/conduct disorders are some of the commonest reasons for referral to youth mental health services; nevertheless, the efficacy of therapeutic interventions in real-world clinical practice remains unclear. In order to define more appropriate targets for innovative pharmacological therapies for disruptive/conduct disorders, the European Commission within the Seventh Framework Programme (FP7) funded the MATRICS project (Multidisciplinary Approaches to Translational Research in Conduct Syndromes) to identify neural, genetic, and molecular factors underpinning the pathogenesis of aggression/antisocial behavior in preclinical models and clinical samples. Within the program, a multicentre case-control study, followed by a single-blind, placebo-controlled, cross-over, randomized acute single-dose medication challenge, was conducted at two Italian sites. Aggressive children and adolescents with conduct disorder (CD) or oppositional defiant disorder (ODD) were compared to the same age (10–17 y) typically developing controls (TDC) on a neuropsychological tasks battery that included both “cold” (e.g., inhibitory control, decision making) and “hot” executive functions (e.g., moral judgment, emotion processing, risk assessment). Selected autonomic measures (heart rate variability, skin conductance, salivary cortisol) were recorded before/during/after neuropsychological testing sessions. The acute response to different drugs (methylphenidate/atomoxetine, risperidone/aripiprazole, or placebo) was also examined in the ODD/CD cohort in order to identify potential neuropsychological/physiological mechanisms underlying aggression. The paper describes the protocol of the clinical MATRICS WP6-1 study, its rationale, the specific outcome measures, and their implications for a precision medicine approach.

Which Child Will Benefit From a Behavioral Intervention for ADHD? A Pilot Study to Predict Intervention Efficacy From Individual Reward Sensitivity

Objective: This article aims to assess whether individual differences in reward sensitivity can be used to predict which children with attention-deficit/hyperactivity disorder (ADHD) will benefit most from behavioral interventions that include reinforcement. Methods: A 12-week behavioral intervention was offered to 21 children with ADHD and their parents. Reward sensitivity was assessed prior to the intervention using a combination of psychological and physiological measures. ADHD symptoms were assessed pre- and posttreatment using the Strengths and Weaknesses of ADHD and Normal behavior (SWAN) rating scale. Results: Lower scores on one of the questionnaire scales were associated with greater pre/posttreatment differences in ADHD symptoms. Conclusion: We found that pre/posttreatment change was associated with one measure of parent-rated reward sensitivity. Children with low impulsive negative behavior toward gaining reward improved most during treatment. This result suggests that aspects of reward-related behaviors in ADHD may be useful to predict the effectiveness of treatment.

Association between child/adolescent overweight/obesity and conduct disorder: A systematic review and meta-analysis

BACKGROUND

Research findings of the association and its pattern between obesity and psychiatric/psychological comorbidities are not consistent across the types of comorbidities or the study subgroups.

OBJECTIVES

We aimed to perform meta-analysis of cross-sectional studies and longitudinal studies analysing obesity as a risk factor for conduct disorder in order to assess the association between child/adolescent overweight/obesity and conduct disorder.

METHODS

Systematic literature search, study selection and data extraction were performed independently by the two authors. Data were analysed by Comprehensive Meta-analysis software.

RESULTS

Analysis of 13 high-quality cross-sectional studies including 79 027 children and adolescents indicated a significant association between overweight/obesity and conduct disorder among children and adolescents (OR 1.32 [95% CI, 1.18-1.49], I² = 86.68), with no publication bias. Subgroup analyses yielded a significant difference (P < .01) between boys and girls. Analysis of four low- to moderate-quality longitudinal studies (OR 1.11 [95% CI, 0.89-1.38], I² = 57.69) showed no prospective association between overweight/obesity and conduct disorder. Subgroup analysis according to gender revealed a significant positive association for boys and negative association for girls.

CONCLUSIONS

Based on the high-quality cross-sectional data, overweight and obesity are associated with conduct disorder among children and adolescents, affecting boys more frequently than girls. Results of the longitudinal analysis indicated possible association in boys, while girls seem to be protected from conduct disorder. However, these results are very unreliable, indicating the need of well-designed longitudinal studies to elucidate the pattern of association between these disorders.

Increasing Effectiveness of Cognitive Behavioral Therapy for Conduct Problems in Children and Adolescents: What Can We Learn from Neuroimaging Studies?

Cognitive behavioral therapy (CBT) is particularly relevant for children from 7 years on and adolescents with clinical levels of conduct problems. CBT provides these children and adolescents with anger regulation and social problem-solving skills that enable them to behave in more independent and situation appropriate ways. Typically, CBT is combined with another psychological treatment such as behavioral parent training in childhood or an intervention targeting multiple systems in adolescence. The effectiveness of CBT, however, is in the small to medium range. The aim of this review is to describe how the effectiveness of CBT may be improved by paying more attention to a series of psychological functions that have been shown to be impaired in neuroimaging studies: (1) anger recognition, (2) the ability to generate situation appropriate solutions to social problems, (3) reinforcement-based decision making, (4) response inhibition, and (5) affective empathy. It is suggested that children and adolescents first become familiar with these psychological functions during group CBT sessions. In individual sessions in which the parents (and/or child care workers in day treatment and residential treatment) and the child or adolescent participate, parents then learn to elicit, support, and reinforce their child’s use of these psychological functions in everyday life (in vivo practice). In these individual sessions, working on the psychological functions is tailored to the individual child’s characteristic impairments of these functions. CBT therapists may also share crucial social-learning topics with teachers with a view to creating learning opportunities for children and adolescents at school.

Epistemic Trust and the Emergence of Conduct Problems: Aggression in the Service of Communication

Fonagy and colleagues have recently proposed that deficits in the capacity for epistemic trust (i. e., the expectation that interpersonal communication is relevant to the addressee) are fundamental to psychopathology. In this paper, we consider the implications of this hypothesis for understanding the role of aggression in conduct disorder and conduct problems more generally. Our main proposal is to view conduct problems not only as reflecting dysregulation, but as an adaptation that allows communication with others who are (or are perceived to be) unreliable. Our formulation hinges on two propositions. The first one is to view aggression as a modality of communication adapted to scenarios in which the communicator expects the audience to have low epistemic trust in the communicator. The second idea is to conceptualize the failed "unlearning of aggression" as reflecting a lack of interest in maintaining one's reputation as a communicator, which in turn stems from a lack of epistemic trust in other communicators. In this paper, we discuss these ideas and examine how they may account for the developmental pathways that lead young people to develop conduct problems.

Neural processes of reward and punishment processing in childhood and adolescence: An event-related potential study on age differences

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Children and adolescents performed the Monetary Incentive Delay Task.

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We examined anticipatory and outcome ERPs of reward and punishment processing.

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SPN amplitudes for anticipating loss or no gain decreased with increasing age.

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Sensitivity to negative outcomes decreases from childhood to adolescence.

Reward and punishment processing are subject to substantial developmental changes during youth. However, little is known about the neurophysiological correlates that are associated with these developmental changes, particularly with regard to both anticipatory and outcome processing stages. Thus, the aim of this study was to address this research gap in a sample of typically developing children and adolescents.

Fifty-four children and adolescents (8–18 years) performed a Monetary Incentive Delay Task comprising a monetary reward and punishment condition. Using event-related brain potential recordings, the cue-P3 and the stimulus-preceding negativity (SPN) were analyzed during the anticipation phase, while the Reward Positivity and the feedback-P3 were analyzed during the outcome phase.

When anticipating monetary loss or no gain, SPN amplitude in the right hemisphere decreased with age. Moreover, exploratory analyses revealed a decrease in feedback-P3 amplitudes in response to monetary loss with increasing age. No other group differences were observed.

Age-related changes in the SPN and fP3 component suggest that sensitivity to negative outcomes decreases from childhood to late adolescence, supporting the notion that adolescence is associated with reduced harm-avoidance. Longitudinal research including young adults is needed to substantiate our findings and its clinical implications regarding disturbed developmental trajectories in psychiatric populations.

Neurofunctional abnormalities in antisocial spectrum: A meta-analysis of fMRI studies on Five distinct neurocognitive research domains

Past functional magnetic resonance imaging on antisocial subjects have shown important inconsistencies and methodological problems (e.g. heterogeneity in fMRI tasks domain, small sample sizes, analyses on regions-of-interest). We aimed to conduct a meta-analysis of whole-brain fMRI studies on antisocial individuals based on distinct neurocognitive domains. A voxel-based meta-analysis via permutation of subject images (SDM-PSI) was performed on studies using fMRI tasks in the domains of acute threat response, cognitive control, social cognition, punishment and reward processing. Overall, 83 studies were retrieved. Using a liberal statistical threshold, several key regions were identified in the meta-analysis, principally during acute threat response, social cognition and cognitive control tasks. Additionally, we observed that the right amygdala was negatively associated with both callous-unemotional traits and severity of antisocial behaviors, in meta-analyses on region-of-interest and on dimensional studies, respectively. The findings show that the most prominent functional brain deficits arise during acute threat response, social cognitions and cognitive control neurocognitive domains. These results provide substantial insights for our understanding of aberrant neural processing across specific contexts.

Inhibitory Control Deficits in Children with Oppositional Defiant Disorder and Conduct Disorder Compared to Attention Deficit/Hyperactivity Disorder: A Systematic Review and Meta-analysis

Inhibitory control deficits are known to be characteristic of Oppositional Defiant Disorder (ODD), Conduct Disorder (CD), and Attention-Deficit/Hyperactivity Disorder (ADHD); but it is unclear whether children with ODD/CD have inhibitory control problems independent of ADHD comorbidity. Previous reviews of inhibitory control and ODD/CD have only focused on one type of measure of inhibitory control or used non-clinical samples. The current meta-analysis explored inhibitory control problems of children with ODD/CD by systematically reviewing studies where children have a diagnosis of ODD and/or CD. Comparisons were made across 25 studies between children with ODD/CD, ODD/CD + ADHD, ADHD, and healthy controls (HC) on various measures of inhibitory control and ADHD symptomatology to explore impacts of ADHD comorbidity. A small significant effect (g = -0.58, p < .001) suggested children with ODD/CD are likely to have more difficulties with inhibitory control than healthy children. However, comparisons between clinical groups suggested this effect may be due to ADHD symptomatology present in each group. As difficulties with inhibitory control are similar, across clinical groups, a dimensional approach to understanding ODD/CD and ADHD may be more useful to consider in future diagnostic criteria. Similarities across clinical groups highlight that therapeutic approaches that assist children with disruptive behaviours could benefit from teaching children and their families how to cope with inhibitory control deficits.

Dopamine Functioning and Child Externalizing Behavior: A Longitudinal Analysis of Polygenic Susceptibility to Parenting

OBJECTIVE

This study investigated how genetic susceptibility may affect children's sensitivity to parenting practices in their development of externalizing behavior. We created a continuous polygenic index composed of 5 dopamine polymorphisms to investigate the moderating role of dopamine-related genes in shaping parent-child gene-by-environment (Gc×E) interactions. Accumulating research supports that differences in children's dopamine neurotransmission make certain children more susceptible to both negative and positive parenting practices, a "for-better and for-worse" effect.

METHODS

Data from a 3-wave longitudinal study (4 months between waves) on 190 at-risk families with children aged 4 to 8 were used to investigate whether a heightened polygenic index score amplified the associations between negative and positive parenting and later children's externalizing behavior. Parenting practices and child externalizing behavior were assessed by parent-reported questionnaires.

RESULTS

Findings were not in line with the expectation that there was a stronger association between positive and negative parenting and later externalizing behavior for children with higher scores on the polygenic susceptibility index. Rather, children with a lower score on the polygenic susceptibility index showed more later externalizing behavior in response to positive parenting behavior, whereas for children with a higher score on the polygenic index, positive parenting was predictive of relatively lower levels of later child externalizing behavior.

CONCLUSION

The results indicate that not only are children with higher but also lower scores on the polygenic index sensitive to parenting, they suggest that different phenotypical characteristics related to reward processing might underlie these genetic susceptibilities to parenting practices.

Executive functioning and emotion recognition in youth with oppositional defiant disorder and/or conduct disorder

Objectives: Executive functioning and emotion recognition may be impaired in disruptive youth, yet findings in oppositional defiant disorder (ODD) and conduct disorder (CD) are inconsistent. We examined these functions related to ODD and CD, accounting for comorbid attention-deficit/hyperactivity disorder (ADHD) and internalising symptoms.Methods: We compared executive functioning (visual working memory, visual attention, inhibitory control) and emotion recognition between youth (8-18 years old, 123 boys, 55 girls) with ODD (n = 44) or CD (with/without ODD, n = 48), and healthy controls (n = 86). We also related ODD, CD, and ADHD symptom counts and internalising symptomatology to all outcome measures, as well as executive functioning to emotion recognition.Results: Visual working memory and inhibitory control were impaired in the ODD and CD groups versus healthy controls. Anger, disgust, fear, happiness, and sadness recognition were impaired in the CD group; only anger recognition was impaired in the ODD group. Deficits were not explained by comorbid ADHD or internalising symptoms. Visual working memory was associated with recognition of all basic emotions.Conclusions: Our findings challenge the view that neuropsychological impairments in youth with ODD/CD are driven by comorbid ADHD and suggest possible distinct neurocognitive mechanisms in CD versus ODD.

The Forensic Symptoms Inventory-Youth Version-Revised: Development and Age Invariance Testing of a Broad-Spectrum Questionnaire for Forensic Assessment

Covering both individual and neuropsychological factors, the Forensic Symptom Inventory-Youth Version-Revised (FSI-YV-R) is the first broad spectrum questionnaire for adolescents in forensic care, measuring several deficits, such as executive dysfunctions, anger, and inadequate coping to enhance treatment goals and evaluate interventions. In this study, both the factor structure and the measurement and structural invariance of the FSI-YV-R were investigated. The sample consisted of 159 forensic juvenile outpatients (79.9% males and 20.1% females) aged 12 to 19 with a mean age of 16.07 (SD = 1.57). Multi-Group Confirmatory Factor Analyses identified a second-order model (measuring executive functioning) and proved measurement and structural invariant across age groups (younger adolescents, 12-15 years and older adolescents, 16-18 years). Contrary to the expectations none of the FSI-YV-R subscales differentiated between younger adolescents (N = 74) and older adolescents (N = 85). These results and implications for both theory and practice are discussed.

Trajectories of internalising and externalising symptoms and inflammation in the general child population

BACKGROUND

Elevations in inflammatory marker levels have been shown to precede internalising and externalising problems in the general child population. One study has found the reverse, that elevations in inflammatory marker levels in childhood follow internalising and externalising problems. However, the authors did not explore the role of the course of these problems in childhood or adjust for a number of potential confounders including psychosocial stressors and prenatal and perinatal exposures.

AIMS

To investigate the association in childhood between the growth of internalising and externalising symptoms and levels of inflammatory markers, while accounting for potential confounders.

METHODS

Using data from the Avon Longitudinal Study of Parents and Children, we tested the association between the trajectories of internalising (emotional and social) and externalising (hyperactivity and conduct) problems, at ages 4, 6, 8 and 9 years, and levels of C-reactive protein (CRP) and interleukin 6 (IL-6) at age 9 years. We analysed data (n = 4525) using latent growth curve modelling and linear regression.

RESULTS

Children who had increasing levels of internalising symptoms over childhood were more likely to have higher levels of CRP and IL-6 at 9 years of age, even after adjustment for confounders. A one-unit increase in the rate of annual change of internalising symptoms was related to an increase of 12% and 8% in the level of CRP and IL-6, respectively. However, there was no evidence for an association between externalising symptoms and either inflammatory marker.

CONCLUSIONS

This study is the first step towards identifying a robust pathway, via increases in emotional and social difficulties, to elevated inflammation in healthy children. This association, if causal, suggests that effective interventions for children experiencing chronic emotional and social difficulties could also have physical health benefits.

Neurocognitive Deficits in Attention-Deficit/Hyperactivity Disorder With and Without Comorbid Oppositional Defiant Disorder

Objective: Oppositional Defiant Disorder (ODD) is highly prevalent in Attention-Deficit/Hyperactivity Disorder (ADHD) and may account for inconsistencies in findings on neurocognitive functioning in ADHD. Our aim was to assess cool and hot executive functioning (EF) and temporal processing in ADHD with and without comorbid ODD to elucidate the effects of comorbid ODD. Method: ADHD-only (n = 82), ADHD + ODD (n = 82), and controls (n = 82), with mean age 16 years (SD = 3.1), matched for age, gender, IQ, and ADHD type (clinical groups) were assessed on cool EF (inhibition, working memory), hot EF (reinforcement processing, emotion recognition), and temporal processing (time production and reproduction). Results: Individuals with ADHD + ODD showed abnormalities in inhibition, working memory, facial emotion recognition, and temporal processing, whereas individuals with ADHD-only were solely impaired in working memory and time production. Conclusion: Findings suggest that ODD carries a substantial part of the EF deficits observed in ADHD and contrast with current theories of neurocognitive impairments in ADHD.

Gray Matter Changes in the Orbitofrontal-Paralimbic Cortex in Male Youths With Non-comorbid Conduct Disorder

Conduct disorder is one of the most common developmental psychiatric disorders which is characterized by persistent aggressive and antisocial behaviors during childhood or adolescence. Previous neuroimaging studies have investigated the neural correlates underlying CD and demonstrated several constructive findings. However, Individuals with CD are at high risk for comorbidities, which might give rise to the inconsistencies of existed findings. It remains unclear which neuroanatomical abnormalities are specifically related to CD without comorbidities. Using structural magnetic resonance imaging (sMRI) data of 69 CD and 69 typically developing (TD) male youths (aged 14–17 years), the present study aims at investigating gray matter volume alterations of non-comorbid CD (i.e., not comorbid with attention deficit hyperactivity disorder, substance abuse disorder, anxiety or depression). We also examined how regional gray matter volumes were related to callous-unemotional (CU) traits and conduct problems in the CD group. The whole-brain analysis revealed decreased gray matter volumes in the right pre-postcentral cortex, supramarginal gyrus and right putamen in CD youths compared with TD youths. The region-of-interest analyses showed increased gray matter volumes in the superior temporal gyrus (STG) and right orbitofrontal cortex (OFC) in CD youths. Correlation analysis found that gray matter volume in the left amygdala was negatively correlated with CU traits in CD participants. These results demonstrated that gray matter volume in the orbitofrontal-paralimbic cortex, including OFC, STG and amygdala, might characterize the male youths with non-comorbid CD and might contribute to different severe forms and trajectories of CD.

Maternal Elaborative Language in Shared Emotion Talk with ODD Children: Relationship to Child Emotion Competencies

While maternal elaborative reminiscing has been found to be positively connected to children's emotion competencies, little is known about how the quality of maternal talk during mother-child talk about shared emotion events relates to emotional competencies in children with disruptive behavioural disorders. In this study of 68 four to eight year-olds with oppositional defiant disorder and 34 children without a diagnosis there was no evidence of differences between mothers of oppositional defiant disorder (ODD) children and mothers of non-ODD children in their use of emotion descriptors and open-ended questions when discussing emotion events with their child. After controlling for child age, gender, expressive verbal abilities and number of conversational turns, the more the mothers used these devices the poorer child's ability to generate causes for emotions and the lower the child's emotion regulation ability. The association for child emotion regulation was moderated by child's diagnostic status with a notable relationship for ODD mother-child dyads but not for the other group. The implications of the findings for the conceptualisation of mother-child talk and its relationship to the development of emotion competencies in children with disruptive behavioural problems are discussed.

Influence of maltreatment, bullying, and neurocognitive impairment on recidivism in adolescents with conduct disorder: A 3-Year prospective study

We sought to clarify the influence of family developmental conditions (e.g., adverse childhood experiences: ACEs), peer relationships (e.g., bullying), and neurocognitive impairment on recidivism in adolescents with conduct disorder (CD). We interviewed 290 adolescents with CD (265 males, 25 females) who had been admitted to a juvenile justice assessment center for the first time about their offense(s), onset of delinquency, ACEs, and peer relationships. The participants also completed tests of neurocognitive activities and self-report symptom measures: the Symbol Digit Modalities Test (SDMT), the Memory Updating test for the assessment of attention, the Adolescent Dissociative Experiences Scale (A-DES) for the assessment of dissociation, and the Barratt Impulsiveness Scale 11th version (BIS-11) for the assessment of impulsivity. After the family court judgement and discharge, the participants were followed for 3 years. Readmissions to the center during the follow-up period were considered cases of "recidivism." During the follow-up, 102 (35.2%) participants were readmitted to the center. A survival analysis (Cox proportional hazard model) showed that lower age, bullying (as the perpetrator), and impaired cognitive function (e.g., a lower SDMT score) significantly increased recidivism, whereas bullying (as both victim and perpetrator) decreased recidivism. ACEs showed no clear effect on recidivism. Lower age and impaired cognitive function appear to predispose adolescent first-time offenders with CD to recidivism. However, the peer bullying analysis showed that being a perpetrator positively influenced recidivism, whereas being both a victim and a perpetrator negatively influenced recidivism. Further research considering the heterogeneity and comorbidity of CD could clarify bullying's influence on recidivism.

Toward Tailored Interventions: Sympathetic and Parasympathetic Functioning Predicts Responses to an Intervention for Conduct Problems Delivered in Two Formats

Coping Power is an evidence-based preventive intervention for youth with aggressive behavior problems that has traditionally been delivered in small group formats, but because of concerns about potentially diminished effects secondary to aggregation of high-risk youth, an individual format of Coping Power has been developed. The current study examined whether physiological characteristics of the child may provide information about which intervention delivery format works best for that individual. Indicators of sympathetic and parasympathetic nervous system functioning were examined in 360 fourth-grade children (65% male; 76.4% self-reported African-American) who were randomly assigned to Group Coping Power (GCP) or Individual Coping Power (ICP) (Lochman et al. 2015). Longitudinal assessments of teacher- and parent-reported proactive and reactive aggression were collected through a 1-year follow-up. For children with higher initial levels of aggression, those with lower parasympathetic functioning at pre-intervention showed greater reductions in teacher-rated proactive aggression in the ICP condition than the GCP condition. For children with high parasympathetic functioning, there was no differential effect of intervention format. Regardless of intervention format, youth with lower levels of sympathetic functioning at pre-intervention demonstrated greater reductions in teacher-rated proactive aggression. These findings suggest that physiological indicators may be worth considering in future studies examining which youth respond best to specific types of interventions.

Associations of ADHD Symptoms With Smoking and Alternative Tobacco Product Use Initiation During Adolescence

Objective

Recently, use of alternative tobacco products, such as electronic cigarettes (e-cigarettes) and hookah (water-pipe tobacco), has increased among adolescents. It is unknown whether attention-deficit hyperactivity disorder (ADHD) symptoms are associated with initiation of alternative tobacco product use.

Methods

Ninth grade high school students who never used any tobacco product at baseline (N = 1,921) participated in a longitudinal survey from 2014 to 2015. Overall symptomatology and inattention (IN) and hyperactivity-impulsivity (HI) ADHD subtypes were assessed at baseline. Past 6-month e-cigarette, hookah, and combustible cigarette use (yes/no) were reported at three semi-annual follow-ups. Repeated measures logistic regression models assessed the association of baseline ADHD symptoms with likelihood of tobacco product initiation across follow-ups.

Results

For ADHD main effect estimates, unadjusted odds of reporting e-cigarette, hookah, and combustible cigarette use pooled across follow-up time points were 45%, 33%, and 37% greater, respectively, with each increase in one SD-unit of baseline ADHD symptoms in baseline never-users of tobacco products. ADHD was not associated with hookah or combustible cigarette use after adjusting for other risk factors. After adjustment, e-cigarette use initiation remained associated with overall ADHD (odds ratio, OR [95%confidence interval, 95% CI] = 1.22 [1.04, 1.42]) and HI (OR [95% CI] = 1.26 [1.09, 1.47]) symptoms, but not IN symptoms (OR [95% CI] = 1.13 [0.97, 1.32]). ADHD × Time interactions were not significant, suggesting ADHD increased odds of e-cigarette use initiation but did not alter the shape of use trajectory across follow-up among initiators.

Conclusions

Understanding the psychosocial mechanisms underlying the pathway from ADHD to e-cigarette use may advance tobacco product use etiologic theory and prevention practice in the current era in which e-cigarette use is popular among youth.

Irritability and parenting practices as mediational variables between temperament and affective, anxiety, and oppositional defiant problems

Irritability and parenting are potential targets for transdiagnostic studies to identify the common and core dysfunctional characteristics underlying several diagnostic pictures with the goal of addressing these issues in treatment. Our objective was to investigate the different paths from temperament to child psychopathology (affective, anxiety, and oppositional problems) through irritability and parenting using a prospective design from ages 3 to 7. A sample of 614 3-year-old preschoolers was followed at ages 4, 6, and 7. Parents answered questionnaires about temperament (age 3), irritability (age 4), parenting practices (age 6), and psychopathology (age 7). Statistical analyses were carried out through structural equation modeling (SEM) to test the mediation effect of irritability and parenting practices from temperament (negative affectivity and effortful control) through to affective, anxious, and oppositional problems. The proposed model fit the data well. SEM showed (a) an indirect effect from temperament to affective problems, via irritability and positive parenting; (b) a direct effect from negative affectivity to anxiety, plus an indirect effect from both temperament dimensions, via irritability and autonomy parenting practices; and (c) an indirect effect from temperament to oppositional problems, via irritability and punitive parenting. Irritability and parenting are transdiagnostic mediational variables that should be focused on in intervention programs for affective, anxiety, and oppositional problems.

Using biological factors to individualize interventions for youth with conduct problems: Current state and ethical issues

A growing body of evidence suggests that biological factors such as genes, hormone levels, brain structure, and brain functioning influence the development and trajectory of conduct problems in youth. In addition, biological factors affect how individuals respond to the environment, including how individuals respond to programs designed to prevent or treat conduct problems. Programs designed to reduce behavior problems in youth would have the greatest impact if they were targeted toward youth who need it the most (e.g., who are mostly likely to demonstrate persistent behavior problems) as well as youth who may benefit the most from the program. Biological information may improve our ability to make decisions about which type or level of intervention is best for a particular child, thus maximizing overall effectiveness, but it also raises a number of ethical concerns. These include the idea that we may be providing fewer services to some youth based on biological factors, and that information about biological risk could potentially lead to discrimination or labeling. In this article, I discuss the risks and benefits of using biological information to individualize interventions for youth with conduct problems.

Effects of Behavioral Treatment Modified to Fit Children with Conduct Problems and Callous-Unemotional (CU) Traits

Research suggests that children with conduct problems (CP) and callous-unemotional (CU) traits show a diminished response to behavior therapy, perhaps due to a reward-oriented, punishment insensitive learning style. Children with CP and CU may benefit from personalizing behavioral treatment for them by emphasizing rewards and de-emphasizing punishments. This hypothesis was tested in a sample of 46 children (78.3% boys), ages 7.0 to 12.6 years (M = 9.3, SD = 1.4). All participants met criteria for ODD and ADHD and 63% also met criteria for CD. Participants were oversampled for high CU, but CU scores ranged from average to high. Children received four weeks of modified behavior therapy that emphasized rewards and de-emphasized punishments and four weeks of treatment as usual, which was standard behavior therapy that balanced rewards and punishments. Treatments were implemented in a summer treatment program and compared using a within-subjects design, with order of treatment counterbalanced. Disruptive behavior was equal or slightly higher in modified behavior therapy than in standard behavior therapy on point system measures, but lower on parent weekly ratings. End of treatment ratings showed both treatments produced significant improvements compared to pre-treatment ratings but did not differ from each other. Personalizing behavior therapy for children with CP and CU produced inconsistent findings relative to standard behavior therapy. Behavior therapy is likely to be a necessary part of treatment for children with CP and CU, but treatment personalization efforts may provide some benefit by addressing other deficits shown by these children.

Relation Between Oppositional/Conduct Behaviors and Executive Function Among Youth with Histories of Heavy Prenatal Alcohol Exposure

BACKGROUND

Youth with heavy prenatal alcohol exposure have high rates of behavioral concerns and psychopathology, including increased oppositional and conduct behaviors. The relation between those concerns and executive function (EF) deficits is unknown. We investigated the association of oppositional and conduct behavior and EF in adolescents to inform targeted intervention.

METHODS

Subjects (N = 267) ages 10 to 17 years comprised 3 groups: alcohol-exposed with oppositional/conduct behaviors (AE+), alcohol-exposed without oppositional/conduct behaviors (AE-), and controls (CON). Group differences on direct neuropsychological (Delis-Kaplan Executive Function System [D-KEFS]) and indirect parent-report (Behavior Rating Inventory of Executive Function [BRIEF]) EF measures were tested with multivariate analysis of covariances, followed by univariate analysis of variances and pairwise comparisons. The contribution of attention-deficit/hyperactivity disorder (ADHD) within the AE groups was assessed in secondary analyses.

RESULTS

On the D-KEFS, there was an omnibus main effect of group, with significant main effects on 3 of 6 variables (CON>AE+, AE-). Within the AE groups, ADHD did not alter the results. On the BRIEF, there was an omnibus significant main effect of group, with significant main effects on all scales (CON<AE-<AE+). Within the AE groups, the AE+ group had higher BRIEF scores (i.e., more difficulty) than the AE- group on 4 of 8 subscales when accounting for presence of ADHD.

CONCLUSIONS

EF deficits in youth with histories of prenatal alcohol exposure were confirmed using direct and indirect measures. Oppositional/conduct behaviors related to EF deficits on indirect but not direct EF measures. Greater understanding of the contribution of concurrent psychopathology to long-term outcomes for alcohol-exposed youth requires further investigation.

Risk-Taking Behavior in Attention Deficit/Hyperactivity Disorder (ADHD): a Review of Potential Underlying Mechanisms and of Interventions

PURPOSE OF REVIEW

Attention deficit/hyperactivity disorder (ADHD) is associated with several forms of risk-taking behavior (RTB). This paper aims to examine the scope of ADHD-related RTB, to highlight potential underlying mechanisms of this association, and to review initial evidence for interventions aimed to treat ADHD-related RTB.

RECENT FINDINGS

Multiple lines of evidence indicate that ADHD is associated with real-life RTB across several domains (e.g., reckless driving, substance use, and unprotected sex), which is corroborated by evidence on laboratory risk-taking tasks. Several individual differences, some of them informed by decision theory, e.g., comorbid disorders, parental monitoring, and perceived enlarged benefits of RTB, may explain the link between ADHD and RTB. A number of studies showed that interventions designed for ADHD may reduce RTB. ADHD is linked to RTB across several domains. Decision theory may serve as a conceptual framework for understanding the underlying mechanisms, and thus may inform future research.

Development of the frontal lobe

Development of the frontal lobe is critical to acquisition, execution, and control of a wide range of functions, from basic motor response to complex decision-making. These functions are influenced by contingency-based (e.g., reward and response-cost/punishment) feedback that is mediated through the adaptive integration of fronto-subcortical neural circuitry. The frontal lobe manages incoming information and chooses the appropriate action based on one's goals in a particular context. This aspect of frontal function, while only one component, is crucial to development and maintenance of approach and avoidance behavior central to all human (and animal) behavior. Furthermore, disruptions in fronto-subcortical circuitry governing motivated behavior appear to contribute to a range of developmental disorders, including attention-deficit/hyperactivity disorder (ADHD), and confer vulnerability for psychopathology more broadly. The particular deficits that manifest in altered behavior depend upon the specific circuitry that is compromised due to the functional specificity of distinct regions of the frontal lobe and its interconnections with subcortical structures. Neurobiologic models of motivated behavior provide a valuable framework for characterizing developmental disorders from a transdiagnostic dimensional systems perspective. Improved characterization of approach and avoidance motivation across neurodevelopmental disorders has the potential to inform the development of novel interventions and personalized medicine.

Valence, arousal or both? Shared emotional deficits associated with Attention Deficit and Hyperactivity Disorder and Oppositional/Defiant-Conduct Disorder symptoms in school-aged youth

We examined emotional responses in Attention Deficit Hyperactivity and Oppositional Defiant/Conduct Disorder to affective pictures. Eighty seven children (42 female, M_age = 11.2), with clinical or subclinical symptoms and controls viewed joy, fear, sadness or neutral pictures while heart rate, skin conductance, corrugator and zygomaticus responses were recorded. The moderating role of Callous-Unemotional and anxiety traits was evaluated. Lower resting heart rate and decreased skin conductance across picture types was associated with ADHD symptoms. Decreased heart rate reactivity to fear and sad stimuli was associated with ADHD and ODD/CD. Corrugator and zygomaticus responses were not associated with ADHD or ODD/CD. Findings are mostly consistent with a fearlessness account of disruptive behavior, and seem to also pertain to ADHD, with intact valence systems. Findings are discussed in light of the significance of identifying common pathogenic mechanisms across traditional diagnostic categories, consistent with trans-diagnostic approaches to the study of psychopathology.

Rat behavior and dopamine release are modulated by conspecific distress

Rats exhibit 'empathy' making them a model to understand the neural underpinnings of such behavior. We show data consistent with these findings, but also that behavior and dopamine (DA) release reflects subjective rather than objective evaluation of appetitive and aversive events that occur to another. We recorded DA release in two paradigms: one that involved cues predictive of unavoidable shock to the conspecific and another that allowed the rat to refrain from reward when there were harmful consequences to the conspecific. Behavior and DA reflected pro-social interactions in that DA suppression was reduced during cues that predicted shock in the presence of the conspecific and that DA release observed on self-avoidance trials was present when the conspecific was spared. However, DA also increased when the conspecific was shocked instead of the recording rat and DA release during conspecific avoidance trials was lower than when the rat avoided shock for itself.

Preschool Oppositional Defiant Disorder: A Disorder of Negative Affect, Surgency, and Disagreeableness

Oppositional defiant disorder (ODD) is conceptualized as a disorder of negative affect and low effortful control. Yet empirical tests of trait associations with ODD remain limited. The current study examined the relationship between temperament and personality traits and Diagnostic and Statistical Manual of Mental Disorders (5th ed.) ODD symptom domains and related impairment in a preschool-age sample. Participants were 109 children ages 3-6 (59% male), overrecruited for ODD from the community, and their primary caregivers (87% mothers). ODD symptoms and impairment were measured using the Kiddie-Disruptive Behavior Disorder Schedule, temperament traits were measured using parent report on the Child Behavior Questionnaire and the Laboratory Temperament Assessment Battery, and personality traits were measured using examiner report on the California Child Q-Sort. Results suggest that high negative affect was associated with all three ODD symptom domains, whereas low agreeableness was specifically associated with the angry/irritable ODD symptom domain, and high surgency was associated with the argumentative/defiant and vindictive ODD symptom domains. Negative affect and surgency interacted with agreeableness to predict impairment, but not symptoms: Low agreeableness was associated with high impairment, regardless of other trait levels, whereas high negative affect and high surgency predicted high impairment in the presence of high agreeableness. Overall, results suggest ODD is a disorder of high negative affect. Furthermore, low agreeableness is differentially associated with affective ODD symptoms, and high surgency is associated with behavioral ODD symptoms. These traits interact in complex ways to predict impairment. Therefore, negative affect, agreeableness, and surgency may be useful early markers of ODD symptoms and impairment.