Response perseveration and delayed responding in undersocialized aggressive conduct disorder

Adolescent Temperament Moderates the Relation of Parenting to Antisocial Behavior and Substance Use

Although some studies have found that parental support and control are related negatively to adolescent problem behaviors, little research has examined factors that may qualify the magnitude of those relations. The present study tests whether adolescent temperament moderates the relations of parenting to antisocial behavior and substance use within a community sample (N = 631). The joint and unique contributions of parenting and temperament in the prediction of those problem behaviors were also examined in this study. Results indicate that parenting and temperament evidenced significant joint and unique relations with adolescent antisocial behavior and substance use. Furthermore, temperament moderated the relations between parenting and adolescent problem behaviors, wherein parenting showed stronger relations with antisocial behavior and substance use at higher levels of temperamental risk. The findings supported the contention that individual differences moderate the relations between parenting and problem behaviors and indicate several directions forfuture research.

Motivation, Working Memory, and Decision Making: A Cognitive-Motivational Theory of Personality Vulnerability to Alcoholism

This article presents a cognitive-motivational theory (CMT) of the mechanisms associated with three basic dimensions of personality vulnerability to alcoholism, impulsivity/novelty seeking, harm avoidance, and excitement seeking. CMT describes the interrelationships between activity in basic motivational systems and attentional, decision-making, and working memory processes as the mechanisms associated with variation in each personality trait. Impulsivity/novelty seeking reflects activity in both appetitive and inhibitory motivational systems, greater attention to reward cues, and increased emotional reactivity to reward and frustration. Harm avoidance reflects individual differences in fearfulness and activity in specific inhibitory systems. Excitement seeking reflects the need to engage in appetitive behaviors in less predictable environments to experience positive affect. CMT also describes the impact of working memory and the specific motivational processes underlying each trait dimension on the dynamics ofdecision making from the perspective of decision field theory.

Contingency Enhances Sensitivity to Loss in a Gambling Task with Diminishing Returns

This study examined whether gambling behavior under conditions of diminishing returns differed between participants with histories of contingent (CD group) and noncontingent (NCD group) token delivery. In Phase 1, CD participants accrued tokens by correctly completing a discrimination task; for NCD participants, token accrual was yoked to token delivery of CD participants. In Phase 2, participants could choose to gamble their tokens or end the experiment and exchange their tokens for money. During the gambling task, participants could bet one token per trial. The probability of losses began at 10% and increased incrementally across blocks of 10 trials up to 100%. Overall, participants in the CD group gambled on fewer trials than participants in the NCD group. Costs of token accrual during Phase 1, in terms of number of trials and duration, showed a positive correlation with net tokens for the CD group but not the NCD group. Results are consistent with previous research demonstrating the value-enhancing effects of both prior contingent delivery and effort, and offer evidence that these histories influence sensitivity to loss.

Antisocial behavior, psychopathic features and abnormalities in reward and punishment processing in youth

A better understanding of what leads youth to initially engage in antisocial behavior (ASB) and more importantly persist with such behaviors into adulthood has significant implications for prevention and intervention efforts. A considerable number of studies using behavioral and neuroimaging techniques have investigated abnormalities in reward and punishment processing as potential causal mechanisms underlying ASB. However, this literature has yet to be critically evaluated, and there are no comprehensive reviews that systematically examine and synthesize these findings. The goal of the present review is twofold. The first aim is to examine the extent to which youth with ASB are characterized by abnormalities in (1) reward processing; (2) punishment processing; or (3) both reward and punishment processing. The second aim is to evaluate whether aberrant reward and/or punishment processing is specific to or most pronounced in a subgroup of antisocial youth with psychopathic features. Studies utilizing behavioral methods are first reviewed, followed by studies using functional magnetic resonance imaging. An integration of theory and research across multiple levels of analysis is presented in order to provide a more comprehensive understanding of reward and punishment processing in antisocial youth. Findings are discussed in terms of developmental and contextual considerations, proposed future directions and implications for intervention.

Impulsivity, "advergames," and food intake

BACKGROUND AND OBJECTIVES

Previous studies have focused on the effect of food advertisements on the caloric intake of children. However, the role of individual susceptibility in this effect is unclear. The aim of this study was to examine the role of impulsivity in the effect of advergames that promote energy-dense snacks on children's snack intake.

METHODS

First, impulsivity scores were assessed with a computer task. Then a randomized between-subject design was conducted with 261 children aged 7 to 10 years who played an advergame promoting either energy-dense snacks or nonfood products. As an extra manipulation, half of the children in each condition were rewarded for refraining from eating, the other half were not. Children could eat freely while playing the game. Food intake was measured. The children then completed questionnaire measures, and were weighed and measured.

RESULTS

Overall, playing an advergame containing food cues increased general caloric intake. Furthermore, rewarding children to refrain from eating decreased their caloric intake. Finally, rewarding impulsive children to refrain from eating had no influence when they were playing an advergame promoting energy-dense snacks, whereas it did lead to reduced intake among low impulsive children and children who played nonfood advergames.

CONCLUSIONS

Playing an advergame promoting energy-dense snacks contributes to increased caloric intake in children. The advergame promoting energy-dense snacks overruled the inhibition task to refrain from eating among impulsive children, making it more difficult for them to refrain from eating. The findings suggest that impulsivity plays an important role in susceptibility to food advertisements.

The Continuum of Conscientiousness: The Antagonistic Interests among Obsessive and Antisocial Personalities

The five factor trait of conscientiousness is a supertrait, denoting on one hand a pattern of excessive labor, rigidity, orderliness and compulsivity, and on the other hand a pattern of strict rectitude, scrupulosity, dutifulness and morality. In both respects the obsessive-compulsive personality is conscientious; indeed, it has been labeled a disorder of extreme conscientiousness (Widiger et al., 2009). Antisocial personality disorder, in the present paper, is described as occupying the opposite end of the conscientiousness continuum. The antisocial is impulsive rather than compulsive, illicit rather than licit, and furtive rather than forthright.After clinically comparing the obsessive and antisocial personalities, the present paper invokes evolutionary theory to explain their resultant behavioral, ideological, political and demographic differences

Relationship between impulsivity, snack consumption and children's weight

BACKGROUND

Childhood overweight is a public health problem associated with psychosocial and physical problems. Personality traits, such as impulsivity, may contribute to the development of overweight.

OBJECTIVE

This study examines 1) the association between general impulsivity traits (reward sensitivity and disinhibition) and children's weight, 2) the association between impulsivity traits and unhealthy snack consumption, and 3) the potential mediating role of unhealthy snack consumption in the relationship between impulsivity traits and children's weight.

METHODS

Included were 1,377 parent-child dyads participating in the IVO Nutrition and Physical Activity Child cohorT (INPACT). Children had a mean age of 10 years. Parents completed a questionnaire to measure children's unhealthy snack consumption. Children completed a door-opening task to assess reward sensitivity and completed a questionnaire to measure disinhibition. Children's height and weight were measured to calculate their BMI z-scores. Cross-sectional linear regression analyses were performed to test the associations.

RESULTS

Disinhibition was positively associated with unhealthy snack consumption but not with BMI z-scores. Reward sensitivity was not related to unhealthy snack consumption or to BMI z-scores.

CONCLUSIONS

No evidence was found for a mediating effect of unhealthy snack consumption in the relation between impulsivity traits and children's weight. However, disinhibition appears to have a negative influence on children's unhealthy snack consumption. Future research focusing on food-related impulsivity in addition to general impulsivity will provide additional insight into factors that influence children's unhealthy snack consumption and weight.

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

This review discusses neurobiological studies of oppositional defiant disorder and conduct disorder within the conceptual framework of three interrelated mental domains: punishment processing, reward processing, and cognitive control. First, impaired fear conditioning, reduced cortisol reactivity to stress, amygdala hyporeactivity to negative stimuli, and altered serotonin and noradrenaline neurotransmission suggest low punishment sensitivity, which may compromise the ability of children and adolescents to make associations between inappropriate behaviors and forthcoming punishments. Second, sympathetic nervous system hyporeactivity to incentives, low basal heart rate associated with sensation seeking, orbitofrontal cortex hyporeactiviy to reward, and altered dopamine functioning suggest a hyposensitivity to reward. The associated unpleasant emotional state may make children and adolescents prone to sensation-seeking behavior such as rule breaking, delinquency, and substance abuse. Third, impairments in executive functions, especially when motivational factors are involved, as well as structural deficits and impaired functioning of the paralimbic system encompassing the orbitofrontal and cingulate cortex, suggest impaired cognitive control over emotional behavior. In the discussion we argue that more insight into the neurobiology of oppositional defiance disorder and conduct disorder may be obtained by studying these disorders separately and by paying attention to the heterogeneity of symptoms within each disorder.

Reinforcement sensitivity and risk for psychopathology following exposure to violence: a vulnerability-specificity model in Latino youth

Urban Latino youth are exposed to high rates of violence, which increases risk for diverse forms of psychopathology. The current study aims to increase specificity in predicting responses by testing the hypothesis that youths' reinforcement sensitivity-behavioral inhibition (BIS) and behavioral approach (BAS)-is associated with specific clinical outcomes and increases risk for the development of such problems following exposure to violence. Utilizing a short-term longitudinal design, Latino youth (N = 168) provided reports of BIS/BAS and emotional/behavioral problems at Time 1, exposure to violence between Time 1 and Time 2, and clinical symptoms at Time 2. Results suggested that reinforcement sensitivity moderated the relation between violence exposure and psychopathology, such that increasing levels of BIS were associated with elevated risk for internalizing and posttraumatic stress symptoms following exposure to violence whereas BAS increased risk for externalizing problems. The importance of building on existing knowledge to understand minority youth psychopathology is discussed.

Limbic responses to reward cues correlate with antisocial trait density in heavy drinkers

Antisocial traits are common among alcoholics- particularly in certain subtypes. Although people with antisocial tendencies show atypical brain activation in some emotion and reward paradigms, how the brain reward systems of heavy drinkers (HD) are influenced by antisocial traits remains unclear. We used subjects' preferred alcohol drink odors (AO), appetitive (ApCO) and non-appetitive (NApO) control odors in functional magnetic resonance imaging (fMRI) to determine if reward system responses varied as a function of antisocial trait density (ASD). In this retrospective analysis, we examined 30 HD who had participated in imaging twice: once while exposed to clamped intravenous alcohol infusion targeted to 50mg%, and once during placebo saline infusion. Under placebo, there were positive correlations between ASD and blood oxygenation level dependent (BOLD) activation in the [AO>ApCO] contrast in the left dorsal putamen, while negative correlations were present in medial orbitofrontal cortex (OFC) and the bilateral amygdala. A similar pattern was observed in the correlation with the [AO>NApO] contrast. This inverse relationship between ASD and activation in OFC and amygdala was specific to AO. However, negative correlations between ASD and the [ApCO>NApO] contrast were also present in the insula, putamen, and medial frontal cortex. These data suggest that frontal and limbic reward circuits of those with significant ASD are less responsive to reward cues in general, and particularly to alcohol cues in medial OFC and amygdala. These findings are broadly consistent with the reward deficiency syndrome hypothesis, although positive correlation in the striatum suggests regional variability.

Reduced cortical gray matter volume in male adolescents with substance and conduct problems

Boys with serious conduct and substance problems (Antisocial Substance Dependence (ASD)) repeatedly make impulsive and risky decisions in spite of possible negative consequences. Because prefrontal cortex (PFC) is involved in planning behavior in accord with prior rewards and punishments, structural abnormalities in PFC could contribute to a person's propensity to make risky decisions.

METHODS

We acquired high-resolution structural images of 25 male ASD patients (ages 14-18 years) and 19 controls of similar ages using a 3T MR system. We conducted whole-brain voxel-based morphometric analysis (p<0.05, corrected for multiple comparisons at whole-brain cluster-level) using Statistical Parametric Mapping version-5 and tested group differences in regional gray matter (GM) volume with analyses of covariance, adjusting for total GM volume, age, and IQ; we further adjusted between-group analyses for ADHD and depression. As secondary analyses, we tested for negative associations between GM volume and impulsivity within groups and separately, GM volume and symptom severity within patients using whole-brain regression analyses.

RESULTS

ASD boys had significantly lower GM volume than controls in left dorsolateral PFC (DLPFC), right lingual gyrus and bilateral cerebellum, and significantly higher GM volume in right precuneus. Left DLPFC GM volume showed negative association with impulsivity within controls and negative association with substance dependence severity within patients.

CONCLUSIONS

ASD boys show reduced GM volumes in several regions including DLPFC, a region highly relevant to impulsivity, disinhibition, and decision-making, and cerebellum, a region important for behavioral regulation, while they showed increased GM in precuneus, a region associated with self-referential and self-centered thinking.

Risky decision making in substance dependent adolescents with a disruptive behavior disorder

Of all psychiatric disorders, the disruptive behavior disorders (DBDs) are the most likely to predispose to substance dependence (SD). One possible underlying mechanism for this increased vulnerability is risky decision making. The aim of this study was to examine decision making in DBD adolescents with and without SD. Twenty-five DBD adolescents (19 males) with SD (DBD+SD), 28 DBD adolescents (23 males) without SD (DBD-SD) and 99 healthy controls (72 males) were included in the study. DBD adolescents with co-morbid attention deficit/ hyperactivity disorder (ADHD) were excluded. Risky decision making was investigated by assessing the number of disadvantageous choices in the Iowa gambling task. DBD+SD made significantly more risky choices than healthy controls and DBD-SD. Healthy controls and DBD-SD did not differ on risky decision making. These results suggest that risky decision making is a vulnerability factor for the development of SD in a subgroup of adolescents with DBD without ADHD.

The three latent classes of adolescent delinquency and the risk factors for membership in each class

This study used latent class analysis to examine subpopulation membership based on self-reports of delinquent behaviors obtained from Australian youth. Three discrete identifiable classes were derived based on 51 indicators of physical violence, property damage, minor infractions, drug use, and social delinquency. One class of youth engaged in primarily rule breaking and norm violations including underage alcohol use, typical of this age period. A second class was more actively delinquent emphasizing drug use, trespassing, and various forms of disobedience. A third class of highly delinquent youth differed from their counterparts by endorsing drug use, thievery that involved stealing money, goods, and cars, property damage, gambling, precocious sexual experiences, involvement with pornographic materials, and fighting. Multinomial logistic regression predicting class membership indicated highly delinquent youth were more likely to be older males, use venting coping strategies, and be fun or novelty seeking compared with rule breakers. Findings are discussed in terms of refining current taxonomic arguments regarding the structure of delinquency and implications for prevention of early-stage antisocial behavior.

Attention Deficit Hyperactivity Disorder (ADHD) among longer-term prison inmates is a prevalent, persistent and disabling disorder

BACKGROUND

ADHD is a common and disabling disorder, with an increased risk for coexisting disorders, substance abuse and delinquency. In the present study, we aimed at exploring ADHD and criminality. We estimated the prevalence of ADHD among longer-term prison inmates, described symptoms and cognitive functioning, and compared findings with ADHD among psychiatric outpatients and healthy controls.

METHODS

At Norrtälje Prison, we approached 315 male inmates for screening of childhood ADHD by the Wender Utah Rating Scale (WURS-25) and for present ADHD by the Adult ADHD Self-Report Screener (ASRS-Screener). The response rate was 62%. Further, we assessed 34 inmates for ADHD and coexisting disorders. Finally, we compared findings with 20 adult males with ADHD, assessed at a psychiatric outpatient clinic and 18 healthy controls.

RESULTS

The estimated prevalence of adult ADHD among longer-term inmates was 40%. Only 2 out of 30 prison inmates confirmed with ADHD had received a diagnosis of ADHD during childhood, despite most needed health services and educational support. All subjects reported lifetime substance use disorder (SUD) where amphetamine was the most common drug. Mood and anxiety disorders were present among half of subjects; autism spectrum disorder (ASD) among one fourth and psychopathy among one tenth. Personality disorders were common; almost all inmates presented conduct disorder (CD) before antisocial personality disorder (APD). Prison inmates reported more ADHD symptoms during both childhood and adulthood, compared with ADHD psychiatric outpatients. Further, analysis of executive functions after controlling for IQ showed both ADHD groups performed poorer than controls on working memory tests. Besides, on a continuous performance test, the ADHD prison group displayed poorer results compared with both other groups.

CONCLUSIONS

This study suggested ADHD to be present among 40% of adult male longer-term prison inmates. Further, ADHD and coexisting disorders, such as SUD, ASD, personality disorders, mood- and anxiety disorders, severely affected prison inmates with ADHD. Besides, inmates showed poorer executive functions also when controlling for estimated IQ compared with ADHD among psychiatric outpatients and controls. Our findings imply the need for considering these severities when designing treatment programmes for prison inmates with ADHD.

Attention to Novelty, Fear-Anxiety, and Age: Their Effects on Conduct Problems

The authors investigated the effects of attention to novelty, fear-anxiety, and age on 3 measures of conduct problems. They found several main and interaction effects. The results indicated the presence of the hypothesized 3-way interaction for 2 dependent measures (i.e., conduct problem, socialized aggression); the 3rd dependent measure (i.e., conduct disorder) approached significance (p = .07). Participants who were older, had low attention to novelty, and high fear-anxiety generally had the highest conduct-problem scores among 8 comparison groups. Older students with high attention to novelty and low fear-anxiety had significantly lower conduct-problem scores that were unremarkable. The findings are congruent with J. Gray's (1987) theory of behavioral activation and inhibition, and the results support R. C. Eaves' (1993) integrated theory of human behavior, which postulates that the level of attention to novelty, fear-anxiety, and age interact to produce individuals with conduct problems.

The psychobiology of undersocialized aggressive conduct disorder: A theoretical perspective

Undersocialized aggressive conduct disorder is conceptualized within the framework for personality and motivation of Jeffrey Gray. The disorder is seen as reflecting a dominance of the reward system over the behavioral inhibition system. Evidence for this conceptualizing coming from behavioral, psychophysiological, biochemical, and pharmacological studies is reviewed. Relevant findings from these studies include perseverative responding for reward, indices of inefficient noradrenergic and serotonergic functioning, and electrodermal underresponding. Additional research to test the proposed hypothesis is suggested.

The neuropsychology of conduct disorder

This article reviews evidence from neuropsychological tests that brain dysfunction is a correlate of conduct disorder. Most studies report consistent findings of differential neuropsychological deficits for antisocial samples in verbal and “executive” functions. Neuropsychological measures are related to some of the best indicators of poor outcome for children with conduct symptoms, such as early onset, stability across time, hyperactive symptoms, and aggressiveness. Neuropsychological tests statistically predict variance in antisocial behavior independently of appropriate control variables. This article argues that neuropsychological variables warrant further study as possible causal factors for conduct disorder and presents one developmental perspective on how neuropsychological problems might contribute risk for conduct disorder.

Mark Twain meets DSM-III-R: Conduct disorder, development, and the concept of harmful dysfunction

The Diagnostic and Statistical Manual (3rd ed., rev.) (DSM-III-R) diagnosis of conduct disorder assumes that all children who engage in three or more criterion antisocial behaviors for 6 months or more suffer from a mental disorder. It resists all contextual information about a child's developmental history, capacities, strengths and circumstances, and assumes that the antisocial behavior necessarily stems from an underlying disorder. In this review, we use Mark Twain's narrative of the lives of Tom Sawyer and Huckleberry Finn as a point of departure for questioning the reasonableness of this assumption, and for examining normal as well as pathological pathways to antisocial behavior. We begin by reviewing the status of earlier controversies about the mental disorder concept in the service of documenting the impressive progress of the field in conceptualizing disorder. Next, we examine Wakefield's (1992a, 1992b) recently introduced “harmful dysfunction” concept of mental disorder and employ its criteria to evaluate the hypothesis that chronic antisocial behavior in childhood as defined by DSM-III-R is caused by an underlying mental disorder. We also examine some of the difficulties in discriminating between disorder- and nondisorder-based antisocial behavior, and consider issues that warrant attention in future theoretical and empirical work. Finally, we explore the pragmatic rather than scientific basis for DSM-III-R's mental disorder claim and argue that regardless of its status as a mental disorder, this most troubling and harmful behavior syndrome of childhood deserves the intensive interest, concern, and resources of the scientific and public health communities.

Adolescent aggression and social cognition in the context of personality: impulsivity as a moderator of predictions from social information processing

This study asked how individual differences in social cognition and personality interact in predicting later aggressive behavior. It was hypothesized that the relationship between immediate response evaluations in social information processing (SIP) and later aggressive behavior would be moderated by impulsivity. In particular, the immediate positive evaluations of aggressive responses would be more strongly related to later aggressive behavior for high-impulsive than for low-impulsive individuals, because high-impulsive children would be less likely to integrate peripheral information and consider long-term future consequences of their actions. Participants were 585 adolescents (52% male) and their mothers and teachers from the longitudinal Child Development Project. Structural equation modeling indicated that teacher-reported impulsivity at ages 11-13 moderated the association between adolescents' endorsement of aggressive responses in hypothetical, ambiguous situations and subsequent mother-reported aggressive behavior. Specifically, positive endorsement of aggressive responses at age 13 was significantly related to later aggressive behavior (age 14-17) for participants with high and medium levels of impulsivity, but this association was not significant for participants with low levels of impulsivity. This study provides evidence of personality variables as potential moderators of the link between SIP and behavior.

The interactive influences of friend deviance and reward dominance on the development of externalizing behavior during middle adolescence

This study investigated the interactive effects of friend deviance and reward dominance on the development of externalizing behavior of adolescents in the Child Development Project. Reward dominance was assessed at age 16 by performance on a computer-presented card-playing game in which participants had the choice of either continuing or discontinuing the game as the likelihood of reward decreased and the likelihood of punishment increased. At ages 14 and 16, friend deviance and externalizing behavior were assessed through self-report. As expected, based on motivational balance and response modulation theories, path analysis revealed that age 14 friend deviance predicted age 16 externalizing behavior controlling for age 14 externalizing behavior. Reward dominance was a significant moderator of the relationship between friend deviance and externalizing behavior. The contributions of deviant friends to the development of externalizing behavior were enhanced by adolescents' reward dominance.

Reinforcement sensitivity, coping, and delinquent behaviour in adolescents

Since 1964, the relationship between personality and criminal behaviour has been extensively studied. However, studies, which have examined the Eysenckian dimensions of extraversion, neuroticism and psychoticism have produced mixed results. Gray's [Gray, J. A. (1970). The psychophysiological basis of introversion-extroversion. Behavior Research and Therapy, 8, 249-266] Reinforcement Sensitivity Theory provides an alternative conceptualisation of the role of personality in criminal behaviour, and has generally produced more consistent findings. This study aimed to examine the relationship between reinforcement sensitivity and delinquent behaviour in a sample of 259 adolescents, and to examine the role that coping strategies play in this relationship. Hierarchical regression analyses revealed that use of problem solving mediated the relationship between reward sensitivity and delinquent behaviour, while use of non-productive coping strategies moderated the relationship between BAS drive and delinquency. Consequently, it was suggested that coping skills training could be an effective early intervention for delinquent behaviour.

Why obese children cannot resist food: the role of impulsivity

Facing the undesirable health consequences of being obese, an important question is why some people are not able to resist eating to excess. It is theorized that increased impulsivity at least partly underlies the inability to control eating behaviour; being more impulsive is supposed to make it more difficult to resist food intake. Thirty-three obese children in a residential setting and 31 lean control children are tested. Impulsivity is measured with two behavioural measures (inhibitory control and sensitivity to reward) and questionnaires. Results show that the obese children in treatment were more sensitive to reward and showed less inhibitory control than normal weight children. In addition, the obese children with eating binges were more impulsive than the obese children without eating binges. Most interesting finding was that the children that were the least effective in inhibiting responses, lost less weight in the residential treatment program. To conclude: impulsivity is a personality characteristic that potentially has crucial consequences for the development and maintenance, as well as treatment of obesity.

Temperament and developmental psychopathology

This review discusses conceptual issues in relating temperament to psychopathology, including the disputed relation of temperament to personality in children. A potential integrative framework is discussed that links trait and biological markers of temperament (reactive, incentive-response tendencies) with regulatory processes. This framework is utilized to highlight potential temperamental pathways to specific forms of psychopathology, noting that in some instances their relations may reflect a spectrum model (with psychopathology closely related as an extreme of a temperament-based trait), but in many instances it likely reflects a vulnerability-transaction set of processes. Conduct disorder involves at least two temperamental paths, one emanating from low fear response and one from either high incentive approach or high anger reactivity. Attention deficit hyperactivity disorder also involves at least two temperament pathways, one involving extremely low effortful control and the other likely involving strong approach. Anxiety disorders appear to result from the confluence of high negative emotionality and low effortful control. Hypotheses for future research are presented and limitations discussed.

A risk-taking "set" in a novel task among adolescents with serious conduct and substance problems

OBJECTIVE

Adolescent patients' conduct disorder and substance use disorder symptoms are "risky behaviors" with unpredictable rewards and punishments. The authors asked whether such youths also take excessive risks in new situations without prior learning, peer pressure, or intoxication.

METHOD

Subjects were 20 adolescent patients in a program treating conduct disorder and substance use disorder and 20 controls. All were substance free > or =7 days; underwent substance-related, psychological, and social assessments; and performed the Balloon Analogue Risk Task: mouse presses inflated a computerized "balloon" image, each press earning 1 cent. The 30 balloons "popped" at unpredictable sizes; earnings from popped balloons were lost. A "Collect" response saved current earnings and advanced to the next balloon.

RESULTS

Mean number of inflating presses: patients, 1021 and controls, 705 (p = .001); group differences were stable from the task's beginning. Mean inflating presses before a "collect" response: patients, 38.6 and controls, 24.0 (p = .0005). Mean balloons popped: patients, 9.8 and controls, 6.3 (p = .001). Patients (versus controls) reported more aggressiveness and substance use and perceived less risk from substances. Patients' responses were significantly slower than those of controls.

CONCLUSIONS

From the beginning of this novel task, conduct disorder and substance use disorder patients (compared with controls) took more risks, indicating an initial risk-taking propensity, although patients' slower responses argued against "impulsive, thoughtless" behavior.

Prediction of adolescent outcome in children with disruptive behaviour disorders--a study of neurobiological, psychological and family factors

In this preliminary study we explored the predictive influence of various family, psychological, demographic, and neurobiological characteristics on the persistence of antisocial behaviour in adolescence. Existing data were combined with case-records in a sample of 47 disruptive behaviour disordered (DBD) children who had been treated in in-patient and/or day-treatment units when they were between seven to 12 years old. Parent-rated and self-rated externalizing problem scores and the presence of a DBD diagnosis served as the outcome measures in adolescence. We used linear regression analyses to examine the predictors of adolescent outcome. A lower basal skin conductance level (SCL) was repeatedly found to predict poor adolescent outcome, either when rated by parents or by participants themselves. In addition, comorbid attention-deficit hyperactivity disorder, one aspect of performance on the door-opening task, and a mother of low socioeconomic status also predicted that a child would have more antisocial problems in adolescence, depending on the type of outcome measure. Results of this study support the fearlessness theory, according to which low activity of the autonomous nervous system, as manifested by low SCL, is related to the effectiveness of socializing punishment and accordingly to poor socialization and adolescent outcome.

Executive Functioning in Hyperactive Children as Young Adults: Attention, Inhibition, Response Perseveration, and the Impact of Comorbidity

Tests of several executive functions (EFs) as well as direct observations of symptoms of attention deficit hyperactivity disorder (ADHD) during testing were collected at the young adult follow-up (M = 20 years) on a large sample of hyperactive (H; N = 147) and community control (CC; N = 71) children. The EF tasks included tests of attention, inhibition, and response perseveration. The H group was subdivided into those with and without ADHD (+ or w/o) at follow-up. The H+ADHD group made significantly more inhibition errors than the CC group on a Continuous Performance Test (CPT) and showed more ADHD symptoms while performing the CPT. The H+ADHD group also displayed more ADHD symptoms during a letter cancellation task than did both the hyperactive w/o ADHD and CC groups. Both H groups showed slower reaction times during a Card Playing Task. That subset of hyperactive probands with Conduct Disorder (CD) displayed significantly more perseverative responding on that task than did those without CD, but otherwise it did not differ on any other measures. Current level of anxiety contributed adversely to both CPT commission errors and ADHD behavior during the CPT. Comorbid depression did not contribute to any group differences on these tests. Although developmental improvements were found in both the H and the CC groups in their CPT inattention and inhibition scores since adolescence, the H groups remained distinguishable from the CC groups over this period. We conclude that formerly hyperactive children manifest greater EF deficits at follow-up in the areas of inattention, disinhibition, and slowed reaction time and greater ADHD behavior during testing, but these problems are mostly confined to those with current ADHD. Response perseveration, however, was limited to those hyperactive children with CD by follow-up, consistent with Quay's theory of these two disorders.

Suicidal behaviors and drug abuse: impulsivity and its assessment

Impulsivity appears to play an important role in suicidal behaviors and drug abuse, which are two psychiatric problems that may interact with one another. Interpretation of the literature on impulsivity in these behaviors may be complicated by the variety of measurement techniques for the assessment of impulsivity. There are three general types of impulsivity assessment: self-report, biological, and laboratory behavioral. Because laboratory behavioral measures both meet an operational definition of impulsivity and are sensitive to state-dependent changes in impulsivity, this paper presents data that focuses on laboratory behavioral performance among samples emitting suicidal behaviors or substance abuse. To better account for influence of impulsivity in these psychiatric disturbances, no single source of measurement should be used without the consideration of other types of instruments.

Response perseveration and sensitivity to reward and punishment in boys with oppositional defiant disorder

Response perseveration is the tendency to continue a response set for reward despite punishment. In the present study, response perseveration and sensitivity to reward and punishment were assessed in boys with oppositional defiant disorder (ODD). The study also examined the relation between punishment sensitivity and autonomic arousal. Nineteen ODD boys (mean age 9.8 years) and 20 normal control boys (NC) (mean age 9.7 years) were administered the door-opening task. In this task, the subject chooses either to open the next door or to stop playing; the opening of doors is initially rewarded and then increasingly punished. ODD boys opened more doors than NC boys. Following punishment, ODD boys took less time than NC boys before opening the next door, but did not differ from NC boys in time after reward. Mean skin conductance level was lower in ODD boys than in NC boys. The correlation coefficient between time after punishment and skin conductance level was moderately positive in the total sample. These results suggest that response perseveration in ODD boys is related to low punishment sensitivity and that skin conductance level is a marker of punishment sensitivity.

Attention-deficit hyperactivity disorder (ADHD)

Approaches to the diagnosis and treatment of attention-deficit hyperactivity disorder (ADHD) are undergoing a major change as a result of information from studies on the genetics of ADHD and the use of new neuroimaging technologies. Moreover, pharmacogenomics, although still in its infancy, will provide a basis for much more sophisticated treatment strategies for ADHD, particularly once more information is available about the genetics of ADHD. Even at this point in time, there is some pertinent information available that, although not ready for application in clinical settings, nonetheless provides a broader perspective for the clinician. In terms of etiology, ADHD is a neuropsychiatric disorder. There is a genetic basis in about 80% of the cases, involving a number of different genes, and in about 20% of the cases, ADHD is the result of an acquired insult to the brain. Some individuals likely have both genetic and acquired forms. Although medication works well in many cases of ADHD, optimal treatment of ADHD requires integrated medical and behavioral treatment. The family plays a crucial role in the management of children with ADHD. Because there is often a very high degree of comorbidity between ADHD and learning disabilities, teachers also have a great deal to contribute in the day-to-day management of these children. Early recognition and treatment prevent the development of more serious psychopathology in adolescence and adulthood.

The top and the bottom of ADHD: a neuropsychological perspective

Five models of attention deficit/hyperactivity disorder (ADHD) are reviewed. It is proposed that the cognitive-energetic model provides a reasonably comprehensive account of ADHD by incorporating the features of both the inhibition and delay aversion models. It is suggested that ADHD can only be accounted for by an analysis at three levels: top-down control, specific cognitive processes and energetic factors. It is argued that a refined and conceptually comprehensive neuropsychological battery is needed to advance research in ADHD. A widely distributed neural network involving frontal, basal ganglia, limbic and cerebellar loci seem implicated in ADHD.

Underlying processes in the poor response inhibition of children with Attention-Deficit/Hyperactivity Disorder

This study evaluated the effects of reward, punishment, and reward + punishment on the impulsive responses of ADHD children. The impulsive responses of ADHD and normal control boys (30 per group) were compared during performance of a go/no-go task, administered under reward-only, punishment-only, and reward + punishment conditions. When differences in aggression, anxiety, and IQ between these groups were controlled for, results indicated that the impulsivity levels of the ADHD group were higher than the control group in all three reinforcement conditions. Also, the ADHD group was more impulsive in the reward + punishment condition, compared to the reward-only and punishment-only conditions, and there was no difference between the reward-only and punishment-only conditions. The control groups showed no difference across the three reinforcement conditions. These findings raise the possibility that the poor response inhibition of ADHD children may be related to both a generalized inhibitory deficit and a response modulation deficit.

Brain maturation and subtypes of conduct disorder: interactive effects on p300 amplitude and topography in male adolescents

OBJECTIVE

Adolescents with conduct disorder problems are, on average, at increased risk for a variety of unfortunate adult outcomes, including substance dependence. This study was designed to identify the neurophysiological correlates of different categories of conduct disorder problems as well as the relationship between these correlates and the maturational status of the brain.

METHOD

The subjects were 94 males, aged 14-19 years, recruited from the community. None were recruited from treatment or juvenile justice programs. The subjects varied in the type and number of conduct problem behaviors exhibited prior to age 15. Groups were operationally defined by the relative number (0 versus > or =1) of DSM-IV conduct disorder diagnostic criteria within each of four categories: rules violations, aggression, deceitfulness/theft, and destructiveness. Age was included as an additional grouping factor. P300 electroencephalographic potentials were recorded while subjects performed a task in which rare auditory stimuli were used to signal a change in stimulus-response mapping during a succeeding set of trials.

RESULTS

Analyses revealed that boys with a history of rules violations failed to exhibit the normal maturational increase in P300 amplitude found in boys without a history of rules violations. Topographic analyses of current source densities suggest that the source of the maturational deficit involved P300 generators within the frontal brain. Parietal generators of P300 matured normally.

CONCLUSIONS

The present results are interpreted as reflecting a decrement in frontal brain maturation among boys potentially at risk for substance dependence, antisocial personality disorder, or other forms of adult psychopathology.

Understanding the relations among gender, disinhibition, and disruptive behavior in adolescents

This study examined whether disinhibition shows similar relations with attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) symptomatology among male and female adolescents. The mixed-incentive or punishment condition of Newman's go/no-go task was administered to 172 adolescents. As expected, ADHD symptoms in boys and girls were predictive of disinhibition (i.e., commission errors) in the mixed-incentive but not punishment condition. Also consistent with expectations, CD symptoms in boys were predictive of disinhibition in the mixed-incentive but not punishment condition. In contrast, CD symptoms in girls were not predictive of disinhibition in either condition. These findings are discussed in terms of implications for understanding sex differences in the etiology of ADHD and CD.

Response perseveration in adolescent boys with stable and unstable histories of physical aggression: the role of underlying processes

BACKGROUND

It was unclear whether response perseveration and underlying processes, often related to antisocial externalizing disorders, were also related to histories of physical aggression.

METHOD

Boys of age 13 years were selected on the basis of childhood histories of physical aggression: stable, unstable, and non-aggressive. Performance on a Card Playing Task provided a perseveration index.

RESULTS

Physical aggression, regardless of history, predicted perseveration in adolescence. However, qualitative differences revealed that Neuroticism increased the risk for perseveration only in the unstable aggressive group relative to the other groups. Perseveration in the stable aggressive group maybe related to a more fundamental information-processing deficit.

CONCLUSION

The identification of these processes has implications for developmental theories of physical aggression; they may help discriminate those children who show early physical aggression and who will remain aggressive from those who will only show occasional physical aggression during later childhood.

Ethnic differences in comorbidity among substance-abusing adolescents referred to outpatient therapy

OBJECTIVE

To examine differences in psychiatric comorbidity between African-American and Hispanic substance-abusing adolescents referred for outpatient therapy.

METHOD

Participants were 167 substance-abusing adolescents and their family members who completed an intake assessment. As part of the intake assessment, adolescents and parents were administered the Diagnostic Interview Schedule for Children-Predictive Scales to screen for the presence of nine psychiatric diagnoses representing both externalizing and internalizing disorders.

RESULTS

Both African-American and Hispanic youths presented with high-above-threshold symptom rates of co-occurring disorders. However, both adolescents and parents reported that Hispanic youths (78.3% and 83.9%, respectively) demonstrated greater rates of externalizing symptoms than African-American youths (65.2% and 70.1%, respectively). African-American youths (40%) reported significantly more symptoms of agoraphobia than Hispanic youths (19.5%).

CONCLUSIONS

The presence of high rates of co-occurring internalizing and externalizing problems provides evidence of the need for developing and implementing multifaceted interventions that address the complex emotional and behavioral needs of adolescent substance abusers. Among Hispanic youths in particular, treatments must address constellations of problem behaviors that appear to co-occur and likely represent the child's entrenchment in a deviant subculture.

Disinhibitory psychopathology in male adolescents: discriminating conduct disorder from attention-deficit/hyperactivity disorder through concurrent assessment of multiple autonomic states

T. P. Beauchaine recently proposed a model of autonomic nervous system functioning that predicts divergent patterns of psychophysiological responding across disorders of disinhibition. This model was tested by comparing groups of male adolescents with attention-deficit/hyperactivity disorder (ADHD) and attention-deficit/hyperactivity disorder plus conduct disorder (CD/ADHD) with controls while performing a repetitive motor task in which rewards were administered and removed across trials. Participants then watched a videotaped peer conflict. Electrodermal responding (EDR), cardiac pre-ejection period (PEP), and respiratory sinus arrhythmia (RSA) were monitored. Compared with controls, the ADHD and CD/ADHD participants exhibited reduced EDR. The CD/ADHD group was differentiated from the ADHD and control groups on PEP and from the control group on RSA. Findings are discussed in terms of the motivational and regulational systems indexed. Implications for understanding rates of comorbidity between CD and ADHD are considered.

Is ADHD a disinhibitory disorder?

Attention deficit hyperactivity disorder (ADHD) is widely theorized to stem from dysfunctional inhibitory processes. However, the definition of inhibition is imprecisely distinguished across theories. To clarify the evidence for this conception, the author relies on a heuristic distinction between inhibition that is under executive control and inhibition that is under motivational control (anxiety or fear). It is argued that ADHD is unlikely to be due to a motivational inhibitory control deficit, although suggestions are made for additional studies that could overturn that conclusion. Evidence for a deficit in an executive motor inhibition process for the ADHD combined type is more compelling but is not equally strong for all forms of executive inhibitory control. Remaining issues include specificity to ADHD, whether inhibitory problems are primary or secondary in causing ADHD, role of comorbid anxiety and conduct disorder, and functional deficits in the inattentive ADHD subtype.

The use of laboratory and performance-based measures in the assessment of children and adolescents with conduct disorders

Provides a review of laboratory and performance-based assessment techniques that have been used in research with children who have severe conduct problems. Many of these techniques have proven useful for monitoring the effects of interventions, which seems to be their most immediate clinical use. With further development, several of these techniques have the potential for assessing clinically important processes that may be involved in the development and maintenance of conduct problems in youth, especially processes that may differ across subgroups of children with conduct disorders (CDs). The assessment of such processes could contribute to the development of individualized treatment plans for children and adolescents with CDs. However, a number of theoretical, methodological, and ethical issues limit the clinical utility of these laboratory and performance-based techniques in their current stages of development, especially in their contribution to making initial diagnoses of CDs. These limitations lead to very cautious recommendations for their clinical use.

Card Perseveration Task performance and post-task feeling states: relationship to drug use in adolescents

This study examined whether performance on the Card Perseveration Task (Card Task) and self-report of feeling state after the task are related to self-report of drug use. The evaluation was of 64 adolescents from an adolescent psychiatric outpatient clinic (40 males, aged 15.5 years, SD = 1.6; 24 females aged 16.9 years, SD = 1.5). Drug use histories were obtained using a substance dependence symptom checklist based on DSM-III-R. The Card Task was administered, and after completion, a Post-Task Self-Report (PTSR) was administered. A factor analysis with varimax rotation grouped the 28 items of the PTSR into Distress, Happy, Satisfied, and Wanting to Win subscales. Correlations of drug use with performance on the Card Task and the PTSR subscales were obtained. Cards Played on the Card Task were correlated with alcohol (cc = .31, p < or = .01); marijuana (cc = .35, p < or = .01) and polydrug (cc = .26, p < or = .05) dependence symptoms. Money Won on the Card Task was correlated negatively with nicotine (cc = -.26, p < or = .05) and marijuana (cc = -.27, p < or = .05) dependence symptoms. The PTSR Distress subscale correlated with nicotine (cc = .49, p < or = .001), alcohol (cc = .37, p < or = .01), marijuana (cc = .39, p < or = .01), and polydrug (cc = .49, p < or = .001) dependence symptoms. These findings provide evidence that both the Card Task and feeling states associated with task performance are related to self-reports of drug use.

Relations of age to cognitive and motivational elements of impulse control in boys with and without externalizing behavior problems

In a cross-sectional study of 83 unmedicated boys, 6 to 16 years of age (M = 10.6, SD = 2.1), attending public (N = 48) and therapeutic schools for behaviorally disturbed children (N = 35), we examined relations of externalizing psychopathology to age-dependent change in performance on cognitive and motivational dimensions of impulse control assessed by laboratory tasks. When we controlled for internalizing symptoms and IQ or school achievement, all children showed improving competence with increasing age on both dimensions over the age range of the sample. Children with externalizing problems performed more poorly on both dimensions at all ages than children without such problems. Comparing age-dependent competence for the two groups, a model of convergent maturation in cognitive aspects of impulse control, and a model depicting a stable deficit in motivational aspects of impulse control in those children with externalizing behavior problems, relative to those without such problems, emerged. Studies of individual growth in impulse control, together with correlates of growth, are needed to validate these observations.

Executive cognitive functioning in alcohol use disorders

Executive cognitive functioning (ECF) has been identified as an important determinant in the etiology of alcoholism. ECF represents a "higher-order" cognitive construct involved in the self-regulation of goal-directed behavior. The prefrontal cortex and its subcortical connections represent the primary neurological substrate that subserves ECF. Both alcoholics and individuals at high risk for alcoholism exhibit a mild dysfunction in ECF. However, this deficit appears to be significantly stronger in alcoholics with a comorbid diagnosis of an antisocial personality disorder. Individuals with other disorders that are also highly comorbid with alcoholism, such as attention deficit hyperactivity disorder and conduct disorder, also demonstrate deficits in ECF. As such, compromised ECF may not be specific to alcoholism, but instead, might be a potential underlying etiologic substrate for a number of disorders of behavioral excess-disinhibition. Subsequent to reviewing the literature implicating ECF deficits in alcoholism and comorbid disorders, the authors present a heuristic cognitive-neurobehavioral model of alcoholism implicating the frontostriatal system. Finally, recommendations for the prevention and treatment of alcoholism, based on this model, are discussed.