Conduct disorder: long-term outcomes and intervention effectiveness

Does Conduct, Oppositional Defiant, and Panic Disorder Symptoms Associate with Suicidal Ideations Among African American Adolescents?

Previous studies suggest that mental illness symptoms among adolescents, such as conduct disorder, oppositional defiant disorder, and panic disorder symptoms often associate with suicidal ideations. Despite this, few studies have examined whether these mental illness symptoms associate with suicidal ideations among African American adolescents. To address these limitations, the current study examined whether conduct disorder, oppositional defiant disorder, and panic disorder symptoms associated with suicidal ideations (N = 261). Using binominal logistic regression, results suggest that conduct disorder symptoms were associated with a higher likelihood of endorsing suicidal ideations than oppositional defiant disorder symptoms. Finally, panic disorder symptoms and gender differences were not associated with suicidal ideations. Preventive efforts and psychotherapy implications are discussed.

Gun violence among young adults with a juvenile crime record in North Carolina: Implications for firearm restrictions based on age and risk

Youth who acquire a juvenile crime record may be at increased risk of perpetrating gun violence as adults. North Carolina and 22 other states permit young adults who were adjudicated by a juvenile court - even for some felony-equivalent offenses - to legally access firearms. Effectiveness of gun restrictions for adults with juvenile crime histories has not been systematically studied. This article reports findings from a longitudinal study of arrests and convictions for gun-involved and other offenses in 51,059 young adults in North Carolina, comparing those with gun-disqualifying and not-disqualifying juvenile records. The annualized rate of arrest for gun-involved crime in those with a felony-level juvenile record was 9 times higher than the rate of reported comparable offenses in the same age group in the North Carolina general population (3349 vs. 376 per 100,000). Among those with a felony-equivalent juvenile delinquency adjudication who became legally eligible to possess firearms at age 18, 61.8% were later arrested for any criminal offense, 14.3% for a firearm-involved offense. Crimes with guns were most likely to occur among young adults who had committed more serious (felony or equivalent) offenses before age 18; had been adjudicated at younger ages; acquired a felony conviction as a youth; and spent time in prison. The prevalence of arrests for crimes involving guns among young adults in North Carolina with a gun-disqualifying felony record acquired before age 18 suggests that the federal gun prohibitor conferred by a felony record is not highly effective as currently implemented in this population. From a risk-based perspective, these restrictions appear to be justified; better implementation and enforcement may improve their effectiveness. Gun crime prevention policies and interventions should focus on these populations and on limiting illegal access to firearms.

Conduct disorder symptomatology is associated with an altered functional connectome in a large national youth sample

Conduct disorder (CD), characterized by youth antisocial behavior, is associated with a variety of neurocognitive impairments. However, questions remain regarding the neural underpinnings of these impairments. To investigate novel neural mechanisms that may support these neurocognitive abnormalities, the present study applied a graph analysis to resting-state functional magnetic resonance imaging (fMRI) data collected from a national sample of 4,781 youth, ages 9-10, who participated in the baseline session of the Adolescent Brain Cognitive Development^SM Study (ABCD Study®). Analyses were then conducted to examine the relationships among levels of CD symptomatology, metrics of global topology, node-level metrics for subcortical structures, and performance on neurocognitive assessments. Youth higher on CD displayed higher global clustering (β = .039, 95% CI_corrected [.0027 .0771]), but lower Degree_subcortical (β = -.052, 95% CI_corrected [-.0916 -.0152]). Youth higher on CD had worse performance on a general neurocognitive assessment (β = -.104, 95% CI [-.1328 -.0763]) and an emotion recognition memory assessment (β = -.061, 95% CI [-.0919 -.0290]). Finally, global clustering mediated the relationship between CD and general neurocognitive functioning (indirect β = -.002, 95% CI [-.0044 -.0002]), and Degree_subcortical mediated the relationship between CD and emotion recognition memory performance (indirect β = -.002, 95% CI [-.0046 -.0005]). CD appears associated with neuro-topological abnormalities and these abnormalities may represent neural mechanisms supporting CD-related neurocognitive disruptions.

Psychopathology, psychosocial factors and sexuality of incarcerated sexual offenders in Greek prison

There are few studies in Greece on sexual offenders. The research aims to contribute knowledge and information related to psychopathology, psychosocial factors and the sexuality of this particular category of convicts for sexual offenses. The search took place in the Greek prison in Grevena, where the largest number of sexual offenders are being held. This is a quantitative study and descriptive and inferential statistical methods were used. The study involved 127 sexual detainees and used the STAI, BDI, EPQ, SCL-90 questionnaires and a special sexual behavior questionnaire. The reliability of the tools was high as the lowest price of Cronbach alpha was equal to 0.733 (STAI) and the highest was 0.975 (SCL-90). The Special Sexual Behavior Questionnaire was 0.877 reliable. RESULTS: The results of the research confirmed the heterogeneity of the population of sexual perpetrators in many categories of data. The importance of some factors such as abuse in childhood, substance use, difficulty in having close relationships, and young delinquent behaviour in the subsequent delinquent evolution of the individual also emerged. Our study did not show particularly high levels of psychopathology except for some elements of anxiety and depression. The results also showed the existence of high transient anxiety, while in the subscales Paranoid Idea and Compulsiveness we had the highest average scores and lower in the subscales Phobic Stress, Aggression and Psychoticism. We had high scores on the scale Neuroticism-Stability and the lowest on the scale Psychoticism-Superego. There were no significant differences between adult and pediatric rapists in terms of differences in stress levels and depression. Sexual perpetrators against minors had higher scores than the dimensions Psychoticism-Superego and Neuroticism-Stability. Minor statistically significant differences in the dimensions Aggression, Anxiety, Paranoid Idea and Neuroticism-Stability were also found. The results show that juvenile delinquency is becoming more serious and violent. Substance users are less likely to sexually abuse a minor. As for the early onset of sexual activity, it appears to be associated with an increased risk of adult rape as well as the fact that the perpetrator's sexual abuse during childhood increases the likelihood that as an adult he or she will harm his or her relatives. In terms of sexual behaviour, incarceration in prison burdened almost all sexual problems of detainees with statistically significant differences in sexual desire and erection problems. There was a universal reduction in the sexual behavior of sexual offenders in prison and a universal reduction in all sexual practices used before imprisonment. Masturbation is the main sexual practice in prison. The main gender of sexual attraction is women despite its significant statistical decline. Statistically, attraction to underage girls has also declined, while homosexual and bisexual tendencies have increased, but there are no statistically significant differences. There was also a significant decrease in the use of pornographic material with adult women and minors, while the use of pornographic material with homosexual content increased. CONCLUSIONS: The investigation of psychopathology, sexual behaviour and those psychosocial factors that characterize and determine the lives of sexual offenders, offers important data and knowledge on which we will rely for the development of therapeutic and preventive programs. Future research on sex offenders should focus on further research on psychopathology and how to think about it, as well as the possibility of using reliable relapse prevention tools to protect society as a whole.

Methylphenidate administration promotes sociability and reduces aggression in a mouse model of callousness

RATIONALE

Deficits in empathy constitute a distinctive feature of several psychopathologies, including conduct disorder (CD). The co-occurrence of callous-unemotional (CU) traits, excess rates of aggression and violation of societal norms confers specific risk for adult psychopathy. To date, the off-label use of methylphenidate (MPH) constitutes the drug treatment of choice.

OBJECTIVES

Herein, we tested the therapeutic potential of MPH in a recently devised mouse model recapitulating the core phenotypic abnormalities of CD.

METHODS

Two subgroups of BALB/cJ male mice exhibiting opposite profiles of emotional contagion (i.e. socially transmitted adoption of another's emotional states) were investigated for reactive aggression, sociability, attention control, anxiety-related behaviours and locomotor activity, in response to MPH administration (0.0, 3.0 or 6.0 mg/kg).

RESULTS

Our data indicate that mice selected for excess callousness exhibit phenotypic abnormalities isomorphic to the symptoms of CD: stability of the low emotional contagion trait, increased aggression and reduced sociability. In accordance with our predictions, MPH reduced aggression and increased sociability in callous mice; yet, it failed to restore the low responsiveness to the emotions of a conspecific in pain, isomorphic to CU traits.

CONCLUSIONS

Although our data support the notion that MPH may contribute to the management of excess aggression in CD patients, additional studies shall identify specific treatments to target the callousness domain. The latter, unaffected by MPH in our experimental model, demands focused consideration whereby it constitutes a specifier associated with a worse prognosis.

Short- and Long-Term Effects of Parent Training for Preschool Children With or at Risk of ADHD: A Systematic Review and Meta-Analysis

OBJECTIVE

The aim of the study was to synthesize the evidence of parent training (PT) as an early intervention for preschool children aged 2.5 to 6 years with ADHD or ADHD symptoms.

METHOD

A systematic review and meta-analysis was conducted.

RESULTS

Sixteen studies including 1,003 children were analyzed. Parent-rated outcomes revealed moderate effect sizes (ESs; Hedges' g) of 0.51 for ADHD symptoms, 0.4 for conduct problems, and 0.63 for negative parenting. Based on independent assessment, results were only significant for negative parenting. Parent-rated outcomes were sustained at follow-ups of 3 to 12 months. Program type, intervention modality, and child diagnostic status did not moderate the effect.

CONCLUSION

PT was partially supported as an efficacious intervention for preschool children with ADHD or ADHD symptoms with moderate ESs on parent-rated outcomes, but no significant results on independently assessed ADHD symptoms.

Low empathy-like behaviour in male mice associates with impaired sociability, emotional memory, physiological stress reactivity and variations in neurobiological regulations

Deficits in empathy have been proposed to constitute a hallmark of several psychiatric disturbances like conduct disorder, antisocial and narcissistic personality disorders. Limited sensitivity to punishment, shallow or deficient affect and reduced physiological reactivity to environmental stressors have been often reported to co-occur with limited empathy and contribute to the onset of antisocial phenotypes. Empathy in its simplest form (i.e. emotional contagion) is addressed in preclinical models through the evaluation of the social transmission of emotional states: mice exposed to a painful stimulus display a higher response if in the presence of a familiar individual experiencing a higher degree of discomfort, than in isolation. In the present study, we investigated whether a reduction of emotional contagion can be considered a predictor of reduced sociality, sensitivity to punishment and physiological stress reactivity. To this aim, we first evaluated emotional contagion in a group of Balb/cJ mice and then discretised their values in four quartiles. The upper (i.e. Emotional Contagion Prone, ECP) and the lower (i.e. Emotional Contagion Resistant, ECR) quartiles constituted the experimental groups. Our results indicate that mice in the lower quartile are characterized by reduced sociability, impaired memory of negative events and dampened hypothalamic-pituitary-adrenocortical reactivity to external stressors. Furthermore, in the absence of changes in oxytocin receptor density, we show that these mice exhibit elevated concentrations of oxytocin and vasopressin and reduced density of BDNF receptors in behaviourally-relevant brain areas. Thus, not only do present results translate to the preclinical investigation of psychiatric disturbances, but also they can contribute to the study of emotional contagion in terms of its adaptive significance.

The clinical usefulness of the new LPE specifier for subtyping adolescents with conduct disorder in the DSM 5

In DSM 5, conduct disorder (CD) has been expanded with a new specifier 'with Limited Prosocial Emotions' (LPE) in addition to the age-of-onset (AoO) subtyping, and is thought to identify a severe antisocial subgroup of CD. However, research in clinical practice has been scarce. Therefore, the current study will examine differences in clinical symptoms between subtypes of CD, based on both subtyping schemes. Subsequently, it will investigate whether the LPE specifier explains unique variance in aggression, added to the AoO subtyping. A sample of 145 adolescents with CD (51 % male, mean age 15.0) from a closed treatment institution participated in this study. CD diagnoses and AoO subtype were assessed using a structured diagnostic interview. The LPE specifier was assessed using the callous-unemotional dimension of the Youth Psychopathy Traits Inventory (YPI). Self-reported proactive and reactive aggression, rule-breaking behavior and internalizing problems within the subtypes were compared. Youth with childhood-onset CD and LPE showed significantly more aggression than adolescent-onset CD without LPE (proactive aggression: F = 3.1, p < 0.05, reactive aggression: F = 3.7, p < 0.05). Hierarchical regression revealed that the LPE specifier uniquely explained 7 % of the variance in reactive aggression, additionally to the AoO subtyping. For proactive aggression, the interaction between AoO and the LPE added 4.5 % to the explained variance. Although the LPE specifier may help to identify a more aggressive subtype of CD in adolescents, the incremental utility seems to be limited. Therefore, clinical relevance of the LPE specifier in high-risk adolescent samples still needs to be investigated thoroughly.

Group-based parent training programmes for improving emotional and behavioural adjustment in young children

BACKGROUND

Emotional and behavioural problems in children are common. Research suggests that parenting has an important role to play in helping children to become well-adjusted, and that the first few months and years are especially important. Parenting programmes may have a role to play in improving the emotional and behavioural adjustment of infants and toddlers, and this review examined their effectiveness with parents and carers of young children.

OBJECTIVES

1. To establish whether group-based parenting programmes are effective in improving the emotional and behavioural adjustment of young children (maximum mean age of three years and 11 months); and2. To assess whether parenting programmes are effective in the primary prevention of emotional and behavioural problems.

SEARCH METHODS

In July 2015 we searched CENTRAL (the Cochrane Library), Ovid MEDLINE, Embase (Ovid), and 10 other databases. We also searched two trial registers and handsearched reference lists of included studies and relevant systematic reviews.

SELECTION CRITERIA

Two reviewers independently assessed the records retrieved by the search. We included randomised controlled trials (RCTs) and quasi-RCTs of group-based parenting programmes that had used at least one standardised instrument to measure emotional and behavioural adjustment in children.

DATA COLLECTION AND ANALYSIS

One reviewer extracted data and a second reviewer checked the extracted data. We presented the results for each outcome in each study as standardised mean differences (SMDs) with 95% confidence intervals (CIs). Where appropriate, we combined the results in a meta-analysis using a random-effects model. We used the GRADE (Grades of Recommendations, Assessment, Development, and Evaluation) approach to assess the overall quality of the body of evidence for each outcome.

MAIN RESULTS

We identified 22 RCTs and two quasi-RCTs evaluating the effectiveness of group-based parenting programmes in improving the emotional and behavioural adjustment of children aged up to three years and 11 months (maximum mean age three years 11 months).The total number of participants in the studies were 3161 parents and their young children. Eight studies were conducted in the USA, five in the UK, four in Canada, five in Australia, one in Mexico, and one in Peru. All of the included studies were of behavioural, cognitive-behavioural or videotape modelling parenting programmes.We judged 50% (or more) of the included studies to be at low risk for selection bias, detection bias (observer-reported outcomes), attrition bias, selective reporting bias, and other bias. As it is not possible to blind participants and personnel to the type of intervention in these trials, we judged all studies to have high risk of performance bias. Also, there was a high risk of detection bias in the 20 studies that included parent-reported outcomes.The results provide evidence that group-based parenting programmes reduce overall emotional and behavioural problems (SMD -0.81, 95% CI -1.37 to -0.25; 5 studies, 280 participants, low quality evidence) based on total parent-reported data assessed at postintervention. This result was not, however, maintained when two quasi-RCTs were removed as part of a sensitivity analysis (SMD -0.67, 95% CI -1.43 to 0.09; 3 studies, 221 participants). The results of data from subscales show evidence of reduced total externalising problems (SMD -0.23, 95% CI -0.46 to -0.01; 8 studies, 989 participants, moderate quality evidence). Single study results show very low quality evidence of reductions in externalising problems hyperactivity-inattention subscale (SMD -1.34; 95% CI -2.37 to -0.31; 19 participants), low quality evidence of no effect on total internalising problems (SMD 0.34; 95% CI -0.12 to 0.81; 73 participants), and very low quality evidence of an increase in social skills (SMD 3.59; 95% CI 2.42 to 4.76; 32 participants), based on parent-reported data assessed at postintervention. Results for secondary outcomes, which were also measured using subscales, show an impact on parent-child interaction in terms of reduced negative behaviour (SMD -0.22, 95% CI -0.39 to -0.06; 7 studies, 941 participants, moderate quality evidence), and improved positive behaviour (SMD 0.48, 95% CI 0.17 to 0.79; 4 studies, 173 participants, moderate quality evidence) as rated by independent observers postintervention. No further meta-analyses were possible. Results of subgroup analyses show no evidence for treatment duration (seven weeks or less versus more than eight weeks) and inconclusive evidence for prevention versus treatment interventions.

AUTHORS' CONCLUSIONS

The findings of this review, which relate to the broad group of universal and at-risk (targeted) children and parents, provide tentative support for the use of group-based parenting programmes to improve the overall emotional and behavioural adjustment of children with a maximum mean age of three years and 11 months, in the short-term. There is, however, a need for more research regarding the role that these programmes might play in the primary prevention of both emotional and behavioural problems, and their long-term effectiveness.

Predicting Aggressive and Disruptive Behavior in Referred 6- to 12-Year-Old Boys

The authors investigated the predictive and incremental validity of the Early Assessment Risk List for boys (EARL-20B; Augimeri, Koegl, Webster, & Levene, 2001), a structured clinical checklist designed for the professional judgment of risk for aggressive and disruptive behaviors and risk/needs factor-based management of this risk. Seventy-six boys consecutively referred to child psychiatric outpatient clinics in mid-Sweden were evaluated according to the EARL-20B and with independent (not EARL-20B-based) clinical evaluations. The participants were prospectively followed after 6 and 30 months. EARL- 20B-based assessments were positively and moderately associated with aggressive (reactive and proactive aggression) and disruptive behavior (conduct problems and DSM-IV Conduct Disorder) at both subsequent evaluations. Clinical evaluations made without the instrument were not as consistently associated with outcome. Incremental predictive validity over unstructured clinical evaluations and Conduct Disorder at baseline suggested promising clinical utility. The checklist might be used to support clinical decision making for referred boys at risk for continued antisocial behavior.

Developmentally dynamic genome: Evidence of genetic influences on increases and decreases in conduct problems from early childhood to adolescence

The development of conduct problems in childhood and adolescence is associated with adverse long-term outcomes, including psychiatric morbidity. Although genes constitute a proven factor of stability in conduct problems, less is known regarding their role in conduct problems' developmental course (i.e. systematic age changes, for instance linear increases or decreases).Mothers rated conduct problems from age 4 to 16 years in 10,038 twin pairs from the Twins Early Development Study. Individual differences in the baseline level (.78; 95% CI: .68-.88) and the developmental course of conduct problems (.73; 95% CI: .60-.86) were under high and largely independent additive genetic influences. Shared environment made a small contribution to the baseline level but not to the developmental course of conduct problems. These results show that genetic influences not only contribute to behavioural stability but also explain systematic change in conduct problems. Different sets of genes may be associated with the developmental course versus the baseline level of conduct problems. The structure of genetic and environmental influences on the development of conduct problems suggests that repeated preventive interventions at different developmental stages might be necessary to achieve a long-term impact.

Early parental physical punishment and emotional and behavioural outcomes in preschool children

OBJECTIVE

To determine whether there is an association between being smacked by your main caregiver in the first two years and emotional and behavioural problems at age four.

DESIGN

Secondary analysis of data from the Growing Up in Scotland Prospective Study (GUS).

SETTING

Scotland, UK.

PARTICIPANTS

GUS birth cohort children, whose main caregiver had no concerns about their behaviour at 22 months.

EXPOSURE

Ever smacked by main caregiver in first 22 months, as measured by caregiver self-report at 22 months.

MAIN OUTCOME

Emotional and behavioural problems as measured by parental assessment and the Strengths and Difficulties Questionnaire (SDQ) at 46 months.

RESULTS

Preschool children exposed to main caregiver smacking in the first two years were twice as likely to have emotional and behavioural problems as measured by parental assessment [odds ratio (OR) 2.5, 95% confidence interval (CI) 1.9-3.2; absolute risk reduction (ARR) 17.8%, 95% CI 12.1-23.5] and SDQ (OR 2.5, 95% CI 1.7-3.7; ARR 7.5%, 95% CI 3.7-11.5), as children never smacked by their main caregiver. The association remained significant after adjusting for child age and sex, caregiver age, sex, ethnicity, educational attainment and mental health status, sibling number, structural family transitions and socioeconomic status (adj. OR 2.4, 95% CI 1.8-3.2 for parental assessment and adj. OR 2.2, 95% CI 1.4-3.5 for SDQ).

CONCLUSIONS

Parental use of physical punishment in the first two years may be a modifiable risk factor for emotional and behavioural difficulties in preschool children.

Sex differences in the pathways to major depression: a study of opposite-sex twin pairs

OBJECTIVE

The authors sought to clarify the nature of sex differences in the etiologic pathways to major depression.

METHOD

Retrospective and prospective assessments of 20 developmentally organized risk factors and the occurrence of past-year major depression were conducted at two waves of personal interviews at least 12 months apart in 1,057 opposite-sex dizygotic twin pairs from a population-based register. Analyses were conducted by structural modeling, examining within-pair differences.

RESULTS

Sixty percent of all paths in the best-fit model exhibited sex differences. Eleven of the 20 risk factors differed across sexes in their impact on liability to major depression. Five had a greater impact in women: parental warmth, neuroticism, divorce, social support, and marital satisfaction. Six had a greater impact in men: childhood sexual abuse, conduct disorder, drug abuse, prior history of major depression, and distal and dependent proximal stressful life events. The life event categories responsible for the stronger effect in males were financial, occupational, and legal in nature.

CONCLUSIONS

In a co-twin control design, which matches sisters and brothers on genetic and familial-environmental background, personality and failures in interpersonal relationships played a stronger etiologic role in major depression for women than for men. Externalizing psychopathology, prior depression, and specific "instrumental" classes of acute stressors were more important in the etiologic pathway to major depression for men. The results are consistent with previously proposed typologies of major depression that suggest two subtypes that differ in prevalence in women (deficiencies in caring relationships and interpersonal loss) and men (failures to achieve expected goals, with lowered self-worth).

Aggression and disruptive behavior disorders in children and adolescents

Aggression is a common symptom of many psychiatric disorders including attention deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder, Tourette's disorder, mood disorders (including bipolar disorder), substance-related disorders, alcohol-related disorders, mental retardation, pervasive developmental disorders, intermittent explosive disorder and personality disorders (particularly antisocial personality disorder). Many forms of organic brain disorders may present with aggressive behavior. Aggression is common in some epileptic patients and some endocrinological diseases (e.g., diabetes and hyperthyroidism) may be associated with aggressive behavior. Physicians need to rule out many medical and psychiatric disorders before diagnosing aggressive behavior. A thorough diagnostic work up is the most important step in determining the nature of comorbid disorders associated with the behavioral problem. Structured interviews and rating scales completed by patients, parents, teachers and clinicians may aid the diagnosis and provide quantification for the change process related to treatment. The integration of medication, individual and family counseling, educational and psychosocial interventions including the school and community, may increase the effectiveness of interventions. Due to the common association of aggression and disruptive behaviors with attention deficit hyperactivity disorder, psychostimulants including new generation long-acting medications and other nonstimulant medications are considered the drug of choice for managing aggressive behavior and disruptive behavior disorders. Severe aggressive behavior not responding to these medications may require the single or combined use of mood regulators including lithium and/or antispychotic medications. Drugs such as risperidone (Risperdal, Janssen-Cilag) have documented effectiveness and safety in children and adolescents, and can be used in treatment.

Clustering of adolescent health concerns: a latent class analysis of school students in New Zealand

AIMS

The aims of this study are to identify clinically meaningful groups of adolescents based on their engagement in high levels of risk behaviours or severe emotional health concerns and to describe the demographic characteristics of these groups in two populations of school students in New Zealand.

METHODS

A nationally representative sample of secondary school students was surveyed in 2007; alternative education (AE) students in Auckland and Northland were surveyed in 2009. A total of 9107 secondary school students and 335 AE students completed a youth health questionnaire using Internet tablets. Latent class analysis (LCA) was used to identify groups of students on the basis of distinct profiles of their risk behaviours and mental health concerns.

RESULTS

The majority (80%) of students in secondary schools are 'healthy' and report few health concerns, 16% are considered 'risky' or 'distressed', and 4% report 'multiple' risk behaviour profiles or emotional health concerns. In AE, only 21% of students were considered 'healthy' with most featuring in the 'risky' or 'multiple' groups. Females were more likely to be 'distressed', whereas males were more likely to feature in the 'risky' or 'multiple' groups.

CONCLUSIONS

Clinically-concerning health risk behaviours and emotional health concerns 'cluster' in up to 20% of students in secondary schools and up to 79% of students in AE. Gender, ethnic and socio-economic disparities are also observed. This highlights the importance of comprehensive psychosocial assessment and appropriate service provision, particularly for at-risk groups.

One-year follow-up of combined parent and child intervention for young children with ADHD

Efficacies of the Incredible Years (IY) interventions are well-established in children with oppositional defiant disorder (ODD) but not among those with a primary diagnosis of attention-deficit/hyperactivity disorder (ADHD). We sought to evaluate 1-year follow-up outcomes among young children with ADHD who were treated with the IY interventions. Four- to 6-year-olds with ADHD (n = 49, 73% male) participated in 6 months of treatment using the IY parent and child interventions. Immediate posttreatment results indicated improvements in parenting, children's externalizing and attention problems, and social contact at school. At 1-year follow up, 22 of 27 variables that showed significant posttreatment effects demonstrated maintenance to 1-year follow up. Children with higher ODD symptoms at baseline showed more improvement in oppositionality and total behavior problems, and their mothers showed more improvement on harsh discipline scores. Approximately 70 to 75% of children were reported by their parents and teachers to fall below clinical cutoffs on measures of externalizing symptoms at the 1-year follow up (compared to 50% at baseline), and more than 50% fell below clinical cutoffs on measures of hyperactivity and inattentiveness (all were in the clinical range at baseline). Children with ADHD who were treated with the IY parent and child treatment programs showed maintenance of treatment effects 1 year after treatment.

Childhood conduct problems are associated with increased partnership and parenting difficulties in adulthood

This paper uses data from a sample of 337 parents studied at age 30 to examine the linkages between childhood conduct problems assessed at ages 7-9 and later partnership and parenting outcomes. The key findings of this study were: 1) increasing levels of childhood conduct problems were associated with increased risk of partnership difficulties, including relationship ambiguity, inter-partner conflict/violence and lower levels of relationship satisfaction; 2) increasing levels of childhood conduct problems were associated with increased risk of parenting difficulties, including over-reactivity, lax and inconsistent discipline, child physical punishment and lower levels of parental warmth and sensitivity. These findings were consistent across both parent reports and interviewer ratings, and in nearly all cases remained after extensive adjustment for confounding and selection bias. Study findings add to the growing body of evidence documenting the adverse consequences of early conduct problems for later adult interpersonal relationships and parenting behaviors.

Substance use and violent behavior in women with antisocial personality disorder

The purpose of this study was to examine the relationship between substance abuse and dependence and violent behavior in a sample of incarcerated women with antisocial personality disorder (ASPD). Among male populations, substance dependence is associated with aggression and criminal behavior. Individuals with ASPD have more severe substance dependence, including higher symptom counts, earlier age of onset, and more frequent co-morbidity. Incarcerated women have a high prevalence of ASPD and substance dependence, but there has been little detailed work regarding addiction severity. Similarly, work on association of substance abuse and dependence with specific violent behaviors has been limited. This study examined a group of 41 mid-sentence female felons with a diagnosis of ASPD to determine associations with substance abuse and dependence. Data were gathered through administration of the Semi-Structured Assessment of the Genetics of Alcoholism II (SSAGA II). Substance dependence was highly prevalent (i.e., alcohol dependence, 56.1%; opiate dependence, 48.8%; cocaine dependence, 61.0%). While specific diagnoses were not associated with violent behavior and offending, symptom severity (i.e., age of onset, symptom count, co-morbidity) was associated with violent behavior in women dependent on opiates, alcohol, and cocaine. Arrest for an assault 1 was associated with alcohol dependence and opiate dependence. These data suggest that measurement of symptom severity and co-morbidity is important in assessing violent behavior in incarcerated women with ASPD. These findings are potentially important in examining non-incarcerated, substance-dependent women.

Combining parent and child training for young children with ADHD

The efficacy of the Incredible Years parent and child training programs is established in children diagnosed with oppositional defiant disorder but not among young children whose primary diagnosis is attention-deficit/hyperactivity disorder (ADHD). We conducted a randomized control trial evaluating the combined parent and child program interventions among 99 children diagnosed with ADHD (ages 4-6). Mother reported significant treatment effects for appropriate and harsh discipline, use of physical punishment, and monitoring, whereas fathers reported no significant parenting changes. Independent observations revealed treatment effects for mothers' praise and coaching, mothers' critical statements, and child total deviant behaviors. Both mothers and fathers reported treatment effects for children's externalizing, hyperactivity, inattentive and oppositional behaviors, and emotion regulation and social competence. There were also significant treatment effects for children's emotion vocabulary and problem-solving ability. At school teachers reported treatment effects for externalizing behaviors and peer observations indicated improvements in treated children's social competence.

Age-of-onset or behavioral sub-types? A prospective comparison of two approaches to characterizing the heterogeneity within antisocial behavior

There are two common approaches to sub-typing the well-documented heterogeneity within antisocial behavior: age-of-onset (i.e., childhood-onset versus adolescence-onset; see Moffitt 1993) and behavioral (i.e., physical aggression versus non-aggressive rule-breaking). These approaches appear to be associated, such that aggression is more characteristic of childhood-onset antisocial behavior whereas rule-breaking is linked to both child- and adolescence-onset antisocial behavior. However, it remains unclear which approach, if either, better explains the heterogeneity within antisocial behavior. We examined this question in a prospective sample of male twins, assessed at the ages of 11, 14, 17, and 24 years. Although the age-of-onset subtypes predicted adult antisocial behavior in the expected direction when analyzed alone, this association dissipated once we controlled for aggression and rule-breaking. Such findings suggest that the behavioral sub-types of antisocial behavior may be a stronger predictor of later antisocial outcomes than is its age-of-onset.

Group-based parent-training programmes for improving emotional and behavioural adjustment in children from birth to three years old

BACKGROUND

Emotional and behavioural problems in children are common. Research suggests that parenting has an important role to play in helping children to become well-adjusted, and that the first few months and years are especially important. Parenting programmes may have a role to play in improving the emotional and behavioural adjustment of infants and toddlers. This review is applicable to parents and carers of children up to three years eleven months although some studies included children up to five years old.

OBJECTIVES

To:a) establish whether group-based parenting programmes are effective in improving the emotional and behavioural adjustment of children three years of age or less (i.e. maximum mean age of 3 years 11 months); b) assess the role of parenting programmes in the primary prevention of emotional and behavioural problems.

SEARCH STRATEGY

We searched CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, Sociofile, Social Science Citation Index, ASSIA, National Research Register (NRR) and ERIC. The searches were originally run in 2000 and then updated in 2007/8.

SELECTION CRITERIA

Randomised controlled trials of group-based parenting programmes that had used at least one standardised instrument to measure emotional and behavioural adjustment.

DATA COLLECTION AND ANALYSIS

The results for each outcome in each study have been presented, with 95% confidence intervals. Where appropriate the results have been combined in a meta-analysis using a random-effects model.

MAIN RESULTS

Eight studies were included in the review. There were sufficient data from six studies to combine the results in a meta-analysis for parent-reports and from three studies to combine the results for independent assessments of children's behaviour post-intervention. There was in addition, sufficient information from three studies to conduct a meta-analysis of both parent-report and independent follow-up data. Both parent-report (SMD -0.25; CI -0.45 to -0.06), and independent observations (SMD -0.54; CI -0.84 to -0.23) of children's behaviour produce significant results favouring the intervention group post-intervention. A meta-analysis of follow-up data indicates a significant result favouring the intervention group for parent-reports (SMD -0.28; CI -0.51 to -0.04) but a non-significant result favouring the intervention group for independent observations (SMD -0.19; CI -0.42, 0.05).

AUTHORS' CONCLUSIONS

The findings of this review provide some support for the use of group-based parenting programmes to improve the emotional and behavioural adjustment of children with a maximum mean age of three years eleven months. There is, insufficient evidence to reach firm conclusions regarding the role that such programmes might play in the primary prevention of such problems. There are also limited data available concerning the long-term effectiveness of these programmes. Further research is needed.

Childhood antecedents of adult violent offending in a group of female felons

The purpose of this study was to evaluate potential antecedents of violent felony arrest in a sample of female felons. Among male populations, early onset conduct disorder (CD) with progression to adult anti-social personality disorder (ASPD) is associated with increased criminality and aggression. Conduct disorder is associated with a worsened trajectory of alcohol dependence in men. These factors likely have a synergistic contribution to male adult violent offending. Existing work suggests that CD, ASPD, and severe alcohol dependence may represent an externalizing endophenotype, which is, at least in part, genetically conferred. These associations have not been well studied in female populations. The author examined a sample (N = 130) of female mid-sentence felons to determine associations between adult arrest for violent felony with child and young adult antecedents, including CD and alcohol dependence. Data were gathered through administration of the Semi-Structured Assessment for the Genetics of Alcoholism II (SSAGA II). CD had high prevalence (40.8%), as did ASPD (31.4%) and alcohol dependence (43.8%). Women convicted of violent felonies were more likely to have CD with progression to ASPD, and alcohol dependence. Both alcohol dependence and CD were independently associated with violent offending. These data suggest that the most serious female offenders have psychopathology similar to that of males and that the trajectory of disease and etiology of violent behavior may not be as gender specific as previously presumed.

Do aggression and rule-breaking have different interpersonal correlates? A study of antisocial behavior subtypes, negative affect, and hostile perceptions of others

There is mounting evidence that physical aggression and nonaggressive, rule-breaking delinquency constitute two separable though correlated subtypes of antisocial behavior. Even so, it remains unclear whether these behavioral subtypes have meaningfully different interpersonal correlates, particularly as they are subsumed within the same broad domain of antisocial behavior. To evaluate this, we examined whether hostile perceptions of others (assessed via exposure to a series of neutral unknown faces) were linked to level and type of antisocial behavior aggression vs. rule-breaking, and moreover, whether this association persisted even when also considering the common association with negative affect (as manipulated via written recollection of one's best and worst life experiences). Analyses revealed that aggression, but not rule-breaking, was uniquely tied to hostile perceptions of others. Furthermore, this association persisted over and above the common association of both hostile perceptions and aggression with negative affect (at both trait and state levels). Such results provide additional support for clinically meaningful differences between the behavioral subtypes of aggression and nonaggressive rule-breaking and for the independent role of hostile perceptions in aggressive behavior.

A controlled clinical evaluation of the parents plus children's programme: a video-based programme for parents of children aged 6 to 11 with behavioural and developmental problems

This article describes the development and the clinic-based evaluation of the Parents Plus Children's Programme (PPCP), a group-based video-modelling-assisted programme for parents of children aged 6 to 11 referred to a Child Mental Health Service with significant behavioural problems both with and without associated developmental difficulties. In evaluating the programme, a sequential block design was used to assign 74 parents of children referred to the service to the PPCP group (n = 42) or the Treatment as Usual (TAU) Comparison Group (n = 32). Assessment took place before and immediately following the 8-week intervention for both groups and at 5-month follow-up for the PPCP Group. Compared to the TAU Group postprogramme, the PPCP Group displayed significant reductions in total difficulties and conduct problems as measured by the Strengths and Difficulties Questionnaire, decreased parental stress, increased parental confidence and significant improvements in parent-defined problems and goals. These positive changes were maintained at 5-month follow-up for the PPCP group, in addition to further significant improvements in peer problems and prosocial behaviour. The analysis also suggests that the programme is more effective for parents of children with behavioural problems only, than for those with associated developmental difficulties. The strengths and limitations of the study are discussed, as well as the difficulties of conducting practice-based research.

Development and validation of the Subtypes of Antisocial Behavior Questionnaire

There is converging evidence that physical aggression, rule-breaking, and social aggression constitute meaningfully distinct, if somewhat overlapping, components of the broader construct of antisocial behavior. Indeed, these subtypes appear to have different developmental trajectories, demographic correlates, and personological underpinnings. They also demonstrate important etiological distinctions. One potential limitation to accumulating additional scientific insights into the correlates and origins of these three types of antisocial behavior is the lack of an efficient self-report assessment in the public domain. We developed the 32-item Subtypes of Antisocial Behavior Questionnaire (STAB) to fill this gap. Our goal was to develop a brief measure that could reliably and validly assess each of the three major subtypes of antisocial behavior and that would be freely available for other researchers. The present series of studies provides initial evidence of the factorial validity, internal consistency, and criterion-related validity of the STAB scales. In short, it appears that the STAB is a brief and useful measure that can be used to differentiate and assess physically aggressive, rule-breaking, and socially aggressive forms of antisocial behavior.

Aggressive versus nonaggressive antisocial behavior: distinctive etiological moderation by age

Research has supported the existence of distinct behavioral patterns, demographic correlates, and etiologic mechanisms for aggressive (AGG) versus nonaggressive but delinquent (DEL) antisocial behavior. Though behavioral genetic studies have the potential to further crystallize these dimensions, inconsistent results have limited their contribution. These inconsistencies may stem in part from the limited attention paid to the impact of age. In the current study, the authors thus examined age-related etiological moderation of AGG and DEL antisocial behavior in a sample of 720 sibling pairs (ranging in age from 10 to 18 years) with varying degrees of genetic relatedness. Results reveal that the magnitude of genetic and environmental influences on AGG remained stable across adolescence. By contrast, genetic influences on DEL increased dramatically with age, whereas shared environmental influences decreased. Subsequent longitudinal analyses fully replicated these results. Such findings highlight etiological distinctions between aggression and delinquency, and offer insights into the expression of genetic influences during development.

Psychopharmacological treatment of oppositional defiant disorder

Oppositional defiant disorder (ODD) consists of an enduring pattern of uncooperative, defiant and hostile behaviour toward authority figures that does not involve major antisocial violations and is not accounted for by the developmental stage of the child. The rate of ODD in children and adolescents in the general population has been reported to be between 2% and 16%. The International Classification of Diseases 10th Revision (ICD-10) classifies ODD as a mild form of conduct disorder (CD), and it has been estimated that up to 60% of patients with ODD will develop CD. Therefore, ODD should be identified and treated as early and effectively as possible.In more than one-half of patients with attention-deficit hyperactivity disorder (ADHD), ODD is also part of the clinical picture. There is strong evidence in the literature to suggest that ODD and ADHD overlap; many medications that are used to treat ADHD may also be efficacious in the treatment of ODD. A few studies have reported the positive effects of psychostimulants or atomoxetine in the treatment of ODD associated with ADHD. Patients with ODD and CD with severe aggression may respond well to risperidone, with or without psychostimulants. Mood regulators, alpha(2)-agonists and antidepressants may also have a role as second-line agents in the treatment of ODD and its co-morbidities.

The clinical effectiveness of different parenting programmes for children with conduct problems: a systematic review of randomised controlled trials

BACKGROUND

Conduct problems are common, disabling and costly. The prognosis for children with conduct problems is poor, with outcomes in adulthood including criminal behaviour, alcoholism, drug abuse, domestic violence, child abuse and a range of psychiatric disorders. There has been a rapid expansion of group based parent-training programmes for the treatment of children with conduct problems in a number of countries over the past 10 years. Existing reviews of parent training have methodological limitations such as inclusion of non-randomised studies, the absence of investigation for heterogeneity prior to meta-analysis or failure to report confidence intervals. The objective of the current study was to systematically review randomised controlled trials of parenting programmes for the treatment of children with conduct problems.

METHODS

Standard systematic review methods were followed including duplicate inclusion decisions, data extraction and quality assessment. Twenty electronic databases from the fields of medicine, psychology, social science and education were comprehensively searched for RCTs and systematic reviews to February 2006. Inclusion criteria were: randomised controlled trial; of structured, repeatable parenting programmes; for parents/carers of children up to the age of 18 with a conduct problem; and at least one measure of child behaviour. Meta-analysis and qualitative synthesis were used to summarise included studies.

RESULTS

57 RCTs were included. Studies were small with an average group size of 21. Meta-analyses using both parent (SMD -0.67; 95% CI: -0.91, -0.42) and independent (SMD -0.44; 95% CI: -0.66, -0.23) reports of outcome showed significant differences favouring the intervention group. There was insufficient evidence to determine the relative effectiveness of different approaches to delivering parenting programmes.

CONCLUSION

Parenting programmes are an effective treatment for children with conduct problems. The relative effectiveness of different parenting programmes requires further research.

How can the study of biological processes help design new interventions for children with severe antisocial behavior?

Children with severe antisocial behavior have an increased risk of showing violently aggressive and other forms of problem behavior in adolescence and adulthood. It is well established that both biological and social factors are involved in the development of antisocial behavior. The primary aim of this paper is to discuss the evidence that specific neurobiological systems are involved in the etiology of childhood-onset antisocial behavior. These factors are responsible for the severity of the behavioral problems observed in antisocial children, but they also play a role in their persistence, because they influence children's interactions with their environment. We will discuss the possible causes of disruptions in neurobiological systems in childhood antisocial behavior and point out the implications of these findings for theory and clinical practice. We will argue that familial factors (e.g., genetic influences, early childhood adversity) are linked to negative behavioral outcomes (e.g., antisocial behavior problems) through the mediating and transactional interplay with neurobiological deficits. An investigation of neurobiological functioning in antisocial children might not only indicate which children are most likely to persist in engaging in severe antisocial behavior, but also guide the development of new interventions.

Telehealth: a child and family-friendly approach to mental health-care reform

Limited access to paediatric mental health services and high drop-out rates from treatment result in poor health outcomes for families with children with mental health problems. New ways of delivering care are required. Telehealth is a promising approach. The Family Help programme employs manualized, distance treatment by telephone. Participants in the Family Help programme (both adults and children) have reported a strong therapeutic alliance with their telephone coach. Participants also described how during treatment sessions they felt comfortable and safe in their own home; they did not feel stigmatized or judged; they had little apprehension about self-disclosure and they felt that treatment was delivered at their convenience. Treatment calls were often scheduled after typical working hours. Attrition rates were found to be very low and children actively engaged in the structured, distance treatment. Evidence-based, distance delivery using non-professionals is a promising approach to the delivery of paediatric mental health care.

Developmental epidemiological courses leading to antisocial personality disorder and violent and criminal behavior: effects by young adulthood of a universal preventive intervention in first- and second-grade classrooms

BACKGROUND

Antisocial personality disorder (ASPD), violent and criminal behavior, and drug abuse disorders share the common antecedent of early aggressive, disruptive behavior. In the 1985-1986 school year teachers implemented the Good Behavior Game (GBG), a classroom behavior management strategy targeting aggressive, disruptive behavior and socializing children to the student role. From first through seventh grade the developmental trajectories of 2311 students from 19 Baltimore City Public Schools were examined. We report the GBG impact on these trajectories and ASPD and violent and criminal behavior by age 19-21.

METHODS

In five urban, poor to lower middle class predominately African-American areas, three to four schools were matched and within each set randomly assigned to one of three conditions: (1) GBG, (2) a reading achievement program, or (3) the standard program. Classrooms and teachers were randomly assigned to intervention or control. Measures at 19-21 included self reports and juvenile court and adult incarceration records. GBG impact was assessed via General Growth Mixture Modeling based on repeated measures of aggressive, disruptive behavior.

RESULTS

Three trajectories of aggressive, disruptive behavior were identified. By young adulthood, GBG significantly reduced the rates of ASPD and violent and criminal behavior among males in the persistent high aggressive, disruptive trajectory. REPLICATION: A replication was implemented with the following cohort of first-grade children using the same teachers, but with diminished mentoring and monitoring. Beneficial impact was found among persistent high males through seventh grade. By young adulthood GBG effects on ASPD and violent and criminal behavior were non-significant, but generally in the hypothesized direction.

Parenting and Child Externalizing Behaviors: Are the Associations Specific or Diffuse?

Building upon the link between inadequate parenting and child noncompliance, aggression, and oppositionality, behavioral parent training has been identified as a well-established treatment for externalizing problems in children. Much less empirical attention has been devoted to examining whether inadequate parenting and, in turn, behavioral parent training programs, have specific effects on child externalizing problems or more diffuse effects on both internalizing and externalizing problems. As an initial attempt to examine the specificity of parenting and childhood externalizing problems, this review examines prior research on the association of three parenting behaviors (parental warmth, hostility, and control) with child externalizing versus internalizing problems. Notably, findings revealed relatively little evidence for the specificity of parenting and child externalizing behaviors in the general parenting literature or in the family context of parent depression. Clinical implications and directions for future research are discussed.

Externalizing behaviors among children of HIV seropositive former and current drug users: parent support network factors as social ecological risks

Children affected by their parents' dual drug use and HIV/AIDS face considerable challenges to their psychosocial development, including parent dysfunction and foster care placement. While HIV/AIDS may increase parents' mobilization of social support, their drug use may restrict who is available to help them, with potential implications to the adjustment of their children with whom they remain in contact. This study sought to identify dually affected children's living situations, and parent and parent's support network factors as correlates of children's externalizing problem behaviors. An urban community sample of 462 HIV seropositive, current or former drug-using parents were queried about their children aged 5-15 years old. One hundred ninety-four children were reported by 119 parents. The outcome was children's externalizing behaviors of ever having been suspended or expelled from school, criminal-justice system involvement, or illicit drug or heavy alcohol use. Independent variables included kin and drug users in parent's support network. Generalized estimating equations were used to adjust for the potential correlation of children of the same parent. Among parents, 63% were mothers, 57% current opioid or cocaine users, 85% were African American, 35% had AIDS or CD<200, and 53% had high depressive symptoms (CES-D>or=16); median age was 38. Among children, median age was 12; 23% lived with the nominating parent, 65% with other family, and 11% in non-kin foster care. While only 34% of parents reported child custody, 43% reported daily contact with their child, and 90% reported high emotional closeness. Parents reported externalizing behaviors among 32% of the children. Logistic regression indicated that externalizing behavior was positively associated with parent's physical limitations and proportion of illicit drug users in parent's support network. A significant interaction was found indicating that the effect of parent's support network-level drug use was greater for children living with versus not living with the parent. The model adjusted for parent's current drug use and depressive symptoms, which were not significant. Results indicate that while only a minority of these dually affected children lived with the parent, the parents' physical limitations and embeddedness in drug using support networks, particularly if living with their children, was associated with the children's maladjustment. It is plausible that these factors interfere with parenting, expose the children to conflict or adverse social influences, or obligate children to assume caregiving for their parent. While dually affected children's contact with their parents may have important benefits, results suggest it presents ongoing needs for intervention with the children, their parents, and caregivers.

Distance therapeutic alliance: the participant's experience

Access barriers to services result in extensive wait times. Distance delivery systems with no face-to-face contact are not yet widely accepted because of uncertainty about whether therapeutic alliance can exist. In this study, 131 participants completed a questionnaire designed to explore their distance treatment experience. The majority described positive comments about the relationship formed with their telephone coach including the strength/quality, coach attributes, and the inapprehension to disclose information to the coach. Moreover, 97% reported preference for distance treatment. Acceptance and integration of evidence-based distance delivery systems are a promising approach to primary healthcare reform.

Attachment style, home-leaving age and behavioral problems among residential care children

In a prospective study, the attachment style, home-leaving age, length of time in residential care, and behavioral problems among Israeli residential care children (N = 68), were studied. Data analyses showed that children removed from their homes at a later age suffered from higher levels of anxiety, depression and social problems compared to children taken from their homes at the age of 7 or less. It was also found that a prolonged stay (over 2 years) in residential care was related to higher levels of anxiety and depression. An interaction effect of a child's attachment style and home-leaving age was found in the child's level of aggressive behavior.

Multiple-family group intervention for incarcerated adolescents and their families: a pilot project

The Multiple-Family Group Intervention (MFGI) was developed to address the need for an effective and yet affordable treatment for reducing recidivism for incarcerated adolescents and altering the families' coercive interactional patterns from an affect regulation and attachment perspective. The 8-week MFGI program was conducted in two Indiana juvenile correctional institutions. The research study utilized pre- and postintervention assessments and a 6-month follow-up assessment. Data from both male (n = 43) and female (n=30) adolescents were combined, yielding a total sample of 140 respondents (73 adolescents, 67 caretakers). The 6-month follow-up assessment indicated a recidivism rate of only 44% compared to the national norm of 65-85%. Linear growth models were fit to determine the nature of the changes in adolescent behavior over the three assessments. Adolescents and caregivers reported that adolescents' externalizing behaviors significantly declined over time. Adolescent-reported internalizing symptoms as well as their alcohol and drug use significantly declined over the follow-up period, while caregiver reports of these behaviors showed no change over time. Adolescent-reported attachment to their parents, particularly mothers, increased significantly as did both adolescent and caregiver-reported functional affect regulation.

Neuroendocrine and neurotransmitter correlates in children with antisocial behavior

When antisocial behavior becomes a persistent pattern that affects diverse domains of children's functioning, psychiatrists refer to oppositional defiant disorder (ODD) or conduct disorder (CD). The term disruptive behavior disorder (DBD) covers both ODD and CD. Research shows that in the absence of effective interventions, the prognosis for DBD children is relatively unfavorable: their disorder can extend into adolescence, manifest itself in delinquency, and convert into other psychiatric symptoms, such as addiction or personality disorders. Although environmental factors have traditionally attracted most attention in explaining the origin and persistence of DBDs, it is important not to overlook the vulnerability of the child in the development of antisocial behavior. Relatively few studies have been conducted on the neurobiological factors involved in the development of DBDs in children. In this paper, we explain how problems in hypothalamic-pituitary-adrenal (HPA) axis and serotonergic system functioning could be important factors in the behavioral problems of DBD children. Low fear of punishment and physiological underactivity may predispose antisocial individuals to seek out stimulation or take risks and may explain poor (social) conditioning and socialization. Findings consistent with this hypothesis are presented. Finally, we explain how stress in general, and adverse early life experiences in particular, could have an impact on the development of the HPA and serotonergic systems. An investigation of the neurobiological factors involved in antisocial behavior disorder might ultimately guide the development of new forms of intervention.

Gender-related pathways for behavior problems in the offspring of alcoholic fathers

The objective of the present study was to examine gender differences in the influence of paternal alcoholism on children's social-emotional development and to determine whether paternal alcoholism is associated with a greater number of externalizing symptoms in the male offspring. From the Mannheim Study of Risk Children, an ongoing longitudinal study of a high-risk population, the developmental data of 219 children [193 (95 boys and 98 girls) of non-alcoholic fathers, non-COAs, and 26 (14 boys, 12 girls) of alcoholic fathers, COAs] were analyzed from birth to the age of 11 years. Paternal alcoholism was defined according to the ICD-10 categories of alcohol dependence and harmful use. Socio-demographic data, cognitive development, number and severity of behavior problems, and gender-related differences in the rates of externalizing and internalizing symptoms were assessed using standardized instruments (IQ tests, Child Behavior Checklist questionnaire and diagnostic interviews). The general linear model analysis revealed a significant overall effect of paternal alcoholism on the number of child psychiatric problems (F = 21.872, d.f. = 1.217, P < 0.001). Beginning at age 2, significantly higher numbers of externalizing symptoms were observed among COAs. In female COAs, a pattern similar to that of the male COAs emerged, with the predominance of delinquent and aggressive behavior. Unlike male COAs, females showed an increase of internalizing symptoms up to age 11 years. Of these, somatic complaints revealed the strongest discriminating effect in 11-year-old females. Children of alcoholic fathers are at high risk for psychopathology. Gender-related differences seem to exist and may contribute to different phenotypes during development from early childhood to adolescence.

Toward a comprehensive model of antisocial development: A dynamic systems approach

The purpose of this article is to develop a preliminary comprehensive model of antisocial development based on dynamic systems principles. The model is built on the foundations of behavioral research on coercion theory. First, the authors focus on the principles of multistability, feedback, and nonlinear causality to reconceptualize real-time parent-child and peer processes. Second, they model the mechanisms by which these real-time processes give rise to negative developmental outcomes, which in turn feed back to determine real-time interactions. Third, they examine mechanisms of change and stability in early- and late-onset antisocial trajectories. Finally, novel clinical designs and predictions are introduced. The authors highlight new predictions and present studies that have tested aspects of the model

Predictors of parent training efficacy for child externalizing behavior problems--a meta-analytic review

BACKGROUND

The differential effectiveness of parent training has led researchers to examine a variety of child, parent, and familial variables that may predict treatment response. Studies have identified a diverse set of child, parent psychological/behavioral and demographic variables that are associated with treatment outcome and dropout.

METHOD

The parent training literature was examined to isolate child, parent, and family variables that predict response to parent training for child externalizing behavior problems. A literature review was conducted spanning articles published from 1980 to 2004 of indicated prevention (children with symptoms) and treatment (children with diagnosis) studies. Meta-analyses were conducted to determine standardized effect sizes associated with the identified predictors.

RESULTS

Many of the predictors of treatment response examined in this meta-analysis resulted in moderate standardized effect sizes when study results were subjected to meta-analytic procedures (i.e., low education/occupation, more severe child behavior problems pretreatment, maternal psychopathology). Only low family income resulted in a large standardized effect size. Predictors of drop-out resulted in standardized effect sizes in the small or insubstantial range.

CONCLUSIONS

Response to parent training is often influenced by variables not directly involving the child, with socioeconomic status and maternal mental health being particularly salient factors.

The utility of elementary school TOCA-R scores in identifying later criminal court violence among adolescent females

OBJECTIVE

To evaluate the utility of a teacher-rating instrument (Teacher Observation of Classroom Adaptation-Revised [TOCA-R]) of aggressive behavior during elementary school years in identifying girls at risk of later criminal court violence.

METHOD

A community epidemiological sample of 845 urban public school girls was rated at six time points during elementary school regarding their level of aggressive/disruptive behavior (75% of whom were African American). Criminal violence was measured using juvenile court records. Logistic regression was used to study the strength of the association between early indicators of aggressive behavior and adolescent females' violent outcomes. An extension of the traditional receiver operating characteristics analysis was used to study the accuracy of identifying girls at risk of violence under three different screening and intervention scenarios.

RESULTS

For girls, teacher ratings of aggression were a strong and consistent predictor of later violence across grades 1-5 and were strongest in fifth grade. Three screening scenarios were compared to determine the optimal identification threshold. The screening scenario with a focus on minimizing false negatives yielded the highest value (kappa = 0.803).

CONCLUSIONS

This study supports other studies indicating that early levels of aggressive behavior are strong and robust predictors of later violence among girls but are of limited utility in the early identification of girls at risk, especially when the focus is on reducing both false positives and negatives.