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Lane C, Hogg E, Karwatowska LA, French L, Ranieri VF, Jesnick LGD, Roberts C, Scott S, Senior R, Skinner GC, Kennedy EMM. Personalised interventions for subgroups of children with conduct problems. Cochrane Database Syst Rev 2023; 4:CD012746. [PMID: 37115724 PMCID: PMC10144971 DOI: 10.1002/14651858.cd012746.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND Conduct problems are a range of disruptive behaviours in childhood that are associated with long-term adverse outcomes in adolescence and adulthood, including antisocial behaviour, substance misuse, and poor academic achievement. Children with conduct problems can vary according to age of onset, comorbidities, and environmental factors, and it has been suggested that certain groups of children may have different treatment outcomes. Therefore, it is important to assess the extent to which personalised interventions for different groups of children with conduct problems may affect outcomes. To our knowledge, this is the first review to systematically identify and appraise the effectiveness of personalised interventions, adapted, or developed, for prespecified subgroups of children with conduct problems. OBJECTIVES To assess whether personalised interventions, adapted or developed for subgroups of children with conduct problems are effective in improving outcomes. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search was 1 February 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs), in any setting, in children (aged two to 12 years) with conduct problems and within a prespecified subgroup, comparing a personalised intervention with a non-personalised intervention, waitlist control, or treatment as usual. Personalised interventions included adaptations to standard practice, such as parent-training programmes; other recommended interventions for children with conduct problems; or interventions developed specifically to target subgroups of children with conduct problems. We excluded non-personalised and non-psychological interventions (e.g. pharmacological or dietary intervention). Prespecified subgroups of children with conduct problems, however defined, were eligible for inclusion. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. child conduct problems or disruptive behaviour and 2. ADVERSE EVENTS Our secondary outcomes were 3. personalised treatment outcomes relevant to each subgroup, 4. parenting skills and knowledge, 5. family functioning, engagement and decreased dropout, and 6. educational outcomes. We used GRADE to assess the certainty of the evidence. MAIN RESULTS We identified 13 RCTs (858 participants). Seven studies were conducted in the USA, five in Australia, and one in Germany. Eleven studies reported their source of funding, with five studies receiving grants from the National Institute of Mental Health. In total, 15 different funders supported the studies included in the review. We separated subgroups of children with conduct problems into three broad categories: children with co-occurring conditions (e.g. emotional difficulties), parent characteristics (e.g. conflict between parents), or familial/environmental circumstances (e.g. rural families). All studies delivered a personalised intervention that was adapted or developed for a prespecified subgroup of children with conduct problems. We rated all trials at unclear or high risk of bias in most domains. Below, we report the results of improvement in child conduct problems and disruptive behaviour, personalised treatment outcomes, and parenting skills and knowledge for our main comparison: personalised versus non-personalised interventions. Improvement in child conduct problems and disruptive behaviour Compared with a non-personalised intervention, a personalised intervention may result in a slight improvement in child conduct problems or disruptive behaviour measured using the Eyberg Child Behavior Inventory (ECBI) Problem subscale in the short term (mean difference (MD) -3.04, 95% confidence interval (CI) -6.06 to -0.02; 6 studies, 278 participants; P = 0.05), but may have little to no effect on improving child conduct problems or disruptive behaviour measured by the ECBI Intensity subscale (MD -6.25, 95% CI -16.66 to 4.15; 6 studies, 278 participants; P = 0.24), or the Externalising subscale of the Child Behaviour Checklist (CBCL) (MD -2.19, 95% CI -6.97 to 2.59; 3 studies, 189 participants, P = 0.37) in the short term. We graded the certainty of evidence as very low for all three outcomes, meaning any estimate of effect is very uncertain. Personalised treatment outcomes, relevant to each subgroup Although six studies reported personalised treatment outcomes, relevant to each subgroup, we were unable to pool the data due to differences between the measures used in the studies and the heterogeneity this would produce in analysis. The results for this outcome were inconclusive. Parenting skills and knowledge Although seven studies reported parenting skills and knowledge, we were unable to pool the data due to differences between the measures used in the studies and the heterogeneity this would produce in analysis. The results for this outcome were inconclusive. Adverse events None of the trials reported monitoring adverse events. Summary of results In summary, there is limited evidence that personalised intervention improves child conduct problems, personalised treatment outcomes, relevant to each subgroup, or parenting skills and knowledge compared with a non-personalised intervention. AUTHORS' CONCLUSIONS There is limited evidence for the effectiveness of personalised interventions for subgroups of children with conduct problems. The certainty of evidence for all outcomes was very low, meaning that we have very little confidence in the estimated effects and the true effects may be different to our findings, which will limit the relevance of our findings to clinical decisions. To overcome the limitations of the evidence, large-scale RCTs are needed to determine whether personalised interventions, adapted or developed, for subgroups of children with conduct problems are effective in improving outcomes. Consensus on the most appropriate measures to use in these studies is needed in order to facilitate cross-study comparisons. Persistent conduct problems predict a range of adverse long-term outcomes, so future research should investigate the medium- and long-term effects of personalised treatments. Studies are needed in low- and middle-income countries as well as studies recruiting children aged between nine and 12 years, as they were under-represented in the studies.
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Affiliation(s)
- Chloe Lane
- Tavistock Research Unit, Tavistock and Portman NHS Foundation Trust, London, UK
| | - Elizabeth Hogg
- Tavistock Research Unit, Tavistock and Portman NHS Foundation Trust, London, UK
| | - Lucy A Karwatowska
- Tavistock Research Unit, Tavistock and Portman NHS Foundation Trust, London, UK
| | - Lorna French
- Tavistock Research Unit, Tavistock and Portman NHS Foundation Trust, London, UK
| | - Veronica F Ranieri
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Leah G D Jesnick
- Tavistock Research Unit, Tavistock and Portman NHS Foundation Trust, London, UK
| | | | - Stephen Scott
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Robert Senior
- Tavistock Research Unit, Tavistock and Portman NHS Foundation Trust, London, UK
| | - Guy Cm Skinner
- Tavistock Research Unit, Tavistock and Portman NHS Foundation Trust, London, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Eilis M M Kennedy
- Tavistock Research Unit, Tavistock and Portman NHS Foundation Trust, London, UK
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Kohlhoff J, Cibralic S, Hawes D, Eapen V. Oxytocin receptor gene (OXTR) polymorphisms and social, emotional and behavioral functioning in children and adolescents: a systematic narrative review. Neurosci Biobehav Rev 2022; 135:104573. [PMID: 35149102 DOI: 10.1016/j.neubiorev.2022.104573] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 01/28/2022] [Accepted: 02/06/2022] [Indexed: 10/19/2022]
Abstract
This study systematically reviewed available evidence regarding associations between polymorphisms of the oxytocin receptor (OXTR) gene and socio-emotional and behavioral functioning in children and adolescents. The search yielded 69 articles, which were grouped into nine categories: depression, anxiety, and internalizing symptoms, alcohol abuse, borderline personality disorder, conduct disorder symptoms or diagnosis, autism spectrum disorder, Attention deficit hyperactivity disorder, early childhood attachment and behavior, pro-social skills, and resilience. Direct and/or gene x environment interactions were identified in over half of the studies. ASD and conduct disorder (including callous unemotional traits) were the diagnoses that were most studied and for which there was the strongest evidence of direct links with OXTR polymorphisms. In most studies identifying gene x environment interactions, the candidate OXTR polymorphism was rs53576. Results suggest that OXTR polymorphisms are associated with social, emotional or behavioural functioning in children and adolescents. The mixed findings do, however, highlight the need for further research.
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Affiliation(s)
- Jane Kohlhoff
- School of Psychiatry, Faculty of Medicine and Health, University of New South Wales, Sydney NSW 2052, Australia; Karitane, P.O. Box 241, Villawood NSW 2163, Australia.
| | - Sara Cibralic
- School of Psychiatry, Faculty of Medicine and Health, University of New South Wales, Sydney NSW 2052, Australia.
| | - David Hawes
- School of Psychology, Faculty of Science, University of Sydney, Camperdown NSW 2006, Australia.
| | - Valsamma Eapen
- School of Psychiatry, Faculty of Medicine and Health, University of New South Wales, Sydney NSW 2052, Australia; Academic Unit of Child Psychiatry and Clinical Academic, South West Sydney Local Health District, Liverpool Hospital, Elizabeth Street, Liverpool NSW 2170, Australia.
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Domínguez-Álvarez B, Romero E, López-Romero L, Isdahl-Troye A, Wagner NJ, Waller R. A Cross-Sectional and Longitudinal Test of the Low Sensitivity to Threat and Affiliative Reward (STAR) Model of Callous-Unemotional Traits Among Spanish Preschoolers. Res Child Adolesc Psychopathol 2021; 49:877-889. [PMID: 33624154 DOI: 10.1007/s10802-021-00785-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2021] [Indexed: 10/22/2022]
Abstract
Despite advances in the theoretical and empirical literature, a better understanding of the etiological determinants of callous-unemotional (CU) traits is needed. In this study, we tested the hypotheses advanced by the Sensitivity to Threat and Affiliative Reward (STAR) model, a theoretical framework, which proposes that individual differences in two temperament dimensions, fearlessness and low affiliation, jointly contribute to the development of CU traits. Specifically, we examined the unique and interactive effects of fearlessness and low affiliation on CU traits, both cross-sectionally and longitudinally and within and across informants (teachers and parents) in a large community sample of Spanish preschoolers (N = 2467, 48.1% girls, M = 4.25 years; SD = 0.91). Both fearlessness and low affiliation were independently related to higher CU traits across models. Consistent with the purported relationships outlined in the STAR model, we also found that a significant interaction between fearlessness and low affiliation explained unique variance in CU traits. The results suggested that main and interactive effects were specific to CU traits and not to other related dimensions of psychopathic traits that are measurable in early childhood (i.e. grandiose-deceitfulness and impulse need of stimulation). Thus, we provide new empirical support to the hypotheses generated by the STAR model in relation to the development of CU traits. Fearlessness and low affiliation are potential targets of future child-focused interventions to prevent or treat the development of CU traits and childhood conduct problems.
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Affiliation(s)
- Beatriz Domínguez-Álvarez
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Coruña, Spain.
| | - Estrella Romero
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Coruña, Spain
| | - Laura López-Romero
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Coruña, Spain
| | - Aimé Isdahl-Troye
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Coruña, Spain
| | - Nicholas J Wagner
- Department of Psychological and Brain Sciences, Boston University, Boston, USA
| | - Rebecca Waller
- Department of Psychology, University of Pennsylvania, Philadelphia, USA
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Dugré JR, Potvin S, Dellazizzo L, Dumais A. Aggression and delinquent behavior in a large representative sample of high school students: Cannabis use and victimization as key discriminating factors. Psychiatry Res 2021; 296:113640. [PMID: 33340870 DOI: 10.1016/j.psychres.2020.113640] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Since conduct problems (CP) vary distinctly across youths, better subtyping CP may be an important vehicle to study specific risk factors associated to differential patterns of CP. In a sample of 63,196 adolescents, we employed a two-step method to the identify such CP patterns and to help classify youths based on several sociodemographic and psychopathological risk factors associated with CP. METHODS K-means clustering methods were first used to reduce the heterogeneity of CP by analyzing patterns of aggressive (AGG) and rule-breaking (RB) behaviors. A multi-class Classification and Regression Tree approach was further employed to examine the hierarchical interactions between risk factors specific to the emergence of different CP patterns. RESULTS Results revealed a three-cluster solution: (i) Low AGG-RB, (ii) High AGG and low RB, and (iii) High AGG-RB. The frequency of cannabis use, level of victimization and hyperactivity symptoms were the three factors best discriminating youths' membership to distinct patterns of CP. The model displayed a moderate to strong discriminatory capacity. CONCLUSION Although this study provides evidence of key factors that may increase the risk of youths following specific patterns of disruptive behavior, additional research is necessary to clarify the etiology, longitudinal trajectories and outcomes related to these patterns.
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Affiliation(s)
- Jules R Dugré
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal; Montreal, Canada; Department of Psychiatry and Addictology, Faculty of medicine, University of Montreal; Montreal, Canada
| | - Stéphane Potvin
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal; Montreal, Canada; Department of Psychiatry and Addictology, Faculty of medicine, University of Montreal; Montreal, Canada
| | - Laura Dellazizzo
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal; Montreal, Canada; Department of Psychiatry and Addictology, Faculty of medicine, University of Montreal; Montreal, Canada
| | - Alexandre Dumais
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal; Montreal, Canada; Department of Psychiatry and Addictology, Faculty of medicine, University of Montreal; Montreal, Canada; Institut national de psychiatrie légale Philippe-Pinel; Montreal, Canada.
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Isaksson J, Vadlin S, Olofsdotter S, Åslund C, Nilsson KW. Psychotic-like experiences during early adolescence predict symptoms of depression, anxiety, and conduct problems three years later: A community-based study. Schizophr Res 2020; 215:190-196. [PMID: 31677809 DOI: 10.1016/j.schres.2019.10.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 08/23/2019] [Accepted: 10/12/2019] [Indexed: 12/28/2022]
Abstract
Psychotic-like experiences (PLEs), such as delusions and hallucinations, are risk markers for psychiatric symptoms and functional impairment. However, the unique contribution of PLEs to psychiatric symptoms remains unclear. Thus, the aim of this study was to investigate the effect of PLEs on psychiatric symptoms, adjusting for the baseline of such symptoms. We assessed a community-based cohort of young adolescents (N = 1445; mean age = 14.38 years, SD = 1.04) to establish a baseline and reassessed them three years later (mean age = 17.31 years, SD = 1.04). Participants reported PLEs they had experienced in the last year and any internalizing (depression and anxiety) or externalizing (attention-deficit/hyperactivity disorder and conduct problems) psychiatric symptoms. The experience of more PLEs predicted more internalizing symptoms three years later, and to a lesser extent, more conduct problems as well, even when adjusting for the baseline occurrence of these symptoms. The association was not sex-specific, although girls reported more PLEs than did boys. The strongest predictor of internalizing/externalizing symptoms was the occurrence of those same symptoms at baseline. These findings highlight the importance of PLEs as markers for a wide range of psychiatric symptoms, emphasizing the importance of assessing PLEs in early adolescence.
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Affiliation(s)
- Johan Isaksson
- Department of Neuroscience, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden.
| | - Sofia Vadlin
- Centre for Clinical Research, Västmanland County Hospital Västerås, Uppsala University, Sweden
| | - Susanne Olofsdotter
- Centre for Clinical Research, Västmanland County Hospital Västerås, Uppsala University, Sweden
| | - Cecilia Åslund
- Centre for Clinical Research, Västmanland County Hospital Västerås, Uppsala University, Sweden
| | - Kent W Nilsson
- Centre for Clinical Research, Västmanland County Hospital Västerås, Uppsala University, Sweden
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von Polier GG, Greimel E, Konrad K, Großheinrich N, Kohls G, Vloet TD, Herpertz-Dahlmann B, Schulte-Rüther M. Neural Correlates of Empathy in Boys With Early Onset Conduct Disorder. Front Psychiatry 2020; 11:178. [PMID: 32256406 PMCID: PMC7093593 DOI: 10.3389/fpsyt.2020.00178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 02/25/2020] [Indexed: 12/30/2022] Open
Abstract
Background: A deficit in empathy has repeatedly been described in individuals with conduct disorder (CD), and in particular in those with callous unemotional traits. Until now, little is known about the neural basis of empathy in children and adolescents with early onset conduct disorder. The aim of this study was to examine neural responses during empathizing in children and adolescents with CD with a task that allowed to differentiate between the judgment of the emotional states of other people and the own emotional response to other people's emotional state. Moreover, we investigated associations of callous-unemotional traits and neural activations during empathizing. Methods: Using functional magnetic resonance imaging (fMRI) we investigated 14 boys with early onset CD and 15 typically developing (TDC) age matched controls between 8 and 16 years of age. Happy and sad faces were presented, and participants were asked to either infer the emotional state from the face (other-task) or to judge their own emotional response (self-task). A perceptual decision on faces was used as a control task. Individual empathic abilities and callous unemotional traits were assessed. Results: During the other task, TDC boys showed significantly larger right amygdala responses than CD boys. Higher empathic abilities (as assessed with the Bryant Index of Empathy) were associated with higher responses in the right amygdala within the CD boys and across the entire sample. Moreover, across the entire sample, callous-unemotional traits were negatively related to the BOLD-response in the right amygdala. CD boys showed larger responses in the dorsal and ventral medial prefrontal cortex across tasks and increased activation in dorsal medial prefrontal cortex specifically during the self-conditions, which were also related to empathic abilities within the CD boys. Conclusions: The data emphasize the important role of the amygdala in empathy related emotional processing. Diminished amygdala responses and their association with low empathy suggest a pivotal influence of impaired amygdala processing in early-onset CD, in particular for deficits in empathic behavior and related callous-unemotional-traits. Elevated response in the medial prefrontal cortex in boys with CD point toward increased involvement of brain areas related to self-referential processing and cognitive empathy during empathizing.
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Affiliation(s)
- Georg G von Polier
- Brain & Behaviour (INM-7), Research Centre Jülich, Institute of Neuroscience and Medicine, Jülich, Germany.,Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Ellen Greimel
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Kerstin Konrad
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Medical Faculty, RWTH Aachen University, Aachen, Germany.,JARA-Brain Institute II, Molecular Neuroscience and Neuroimaging, Research Center Jülich, Jülich, Germany
| | - Nicola Großheinrich
- Department of Social Sciences, Institute of Health Research and Social Psychiatry, Catholic University of Applied Sciences of North Rhine-Westphalia, Cologne, Germany
| | - Gregor Kohls
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Timo D Vloet
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Centre of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Beate Herpertz-Dahlmann
- Brain & Behaviour (INM-7), Research Centre Jülich, Institute of Neuroscience and Medicine, Jülich, Germany.,Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Martin Schulte-Rüther
- JARA-Brain Institute II, Molecular Neuroscience and Neuroimaging, Research Center Jülich, Jülich, Germany.,Translational Neuroscience in Psychiatry and Neurology, Department of Child and Adolescent Psychiatry, Medical Faculty, RWTH Aachen University, Aachen, Germany
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Connor DF, Newcorn JH, Saylor KE, Amann BH, Scahill L, Robb AS, Jensen PS, Vitiello B, Findling RL, Buitelaar JK. Maladaptive Aggression: With a Focus on Impulsive Aggression in Children and Adolescents. J Child Adolesc Psychopharmacol 2019; 29:576-591. [PMID: 31453715 PMCID: PMC6786344 DOI: 10.1089/cap.2019.0039] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective: Aggressive behavior is among the most common reasons for referral to psychiatric clinics and confers significant burden on individuals. Aggression remains poorly defined; there is currently no consensus on the best ways to recognize, diagnose, and treat aggression in clinical settings. In this review, we synthesize the available literature on aggression in children and adolescents and propose the concept of impulsive aggression (IA) as an important construct associated with diverse and enduring psychopathology. Methods: Articles were identified and screened from online repositories, including PubMed, PsychInfo, the Cochrane Database, EMBase, and relevant book chapters, using combinations of search terms such as "aggression," "aggressive behavio(u)r," "maladaptive aggression," "juvenile," and "developmental trajectory." These were evaluated for quality of research before being incorporated into the article. The final report references 142 sources, published from 1987 to 2019. Results: Aggression can be either adaptive or maladaptive in nature, and the latter may require psychosocial and biomedical interventions when it occurs in the context of central nervous system psychopathology. Aggression can be categorized into various subtypes, including reactive/proactive, overt/covert, relational, and IA. IA in psychiatric or neurological disorders is reviewed along with current treatments, and an algorithm for systematic evaluation of aggression in the clinical setting is proposed. Conclusions: IA is a treatable form of maladaptive aggression that is distinct from other aggression subtypes. It occurs across diverse psychiatric and neurological diagnoses and affects a substantial subpopulation. IA can serve as an important construct in clinical practice and has considerable potential to advance research.
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Affiliation(s)
- Daniel F. Connor
- Department of Psychiatry, Division of Child & Adolescent Psychiatry, University of Connecticut Medical School, Farmington, Connecticut.,Address correspondence to: Daniel F. Connor, MD, Department of Psychiatry, Division of Child & Adolescent Psychiatry, University of Connecticut Medical School, 263 Farmington Avenue, MC 1410, Farmington, CT 06030-1410
| | - Jeffrey H. Newcorn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Lawrence Scahill
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Adelaide S. Robb
- Department of Psychiatry and Behavioral Sciences, Children's National Medical Center, Washington, District of Columbia.,Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, District of Columbia
| | - Peter S. Jensen
- Department of Psychiatry, University of Arkansas for Medical Science, Little Rock, Arkansas
| | - Benedetto Vitiello
- Section of Child and Adolescent Neuropsychiatry, University of Turin, Turin, Italy
| | - Robert L. Findling
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland.,Department of Psychiatry and Behavioral Sciences, Kennedy Krieger Institute, Baltimore, Maryland
| | - Jan K. Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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Khan S, Down J, Aouira N, Bor W, Haywood A, Littlewood R, Heussler H, McDermott B. Current pharmacotherapy options for conduct disorders in adolescents and children. Expert Opin Pharmacother 2019; 20:571-583. [PMID: 30702354 DOI: 10.1080/14656566.2018.1561862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Conduct disorder (CD) is a common mental health disorder of childhood and adolescence. CD's complexity, with its heterogenous clinical manifestations and overlapping comorbidities makes the application of evidence-based management approaches challenging. This article aims to combine a systematic review of the available literature, with a consensus opinion from both child and adolescent psychiatrists and developmental pediatricians on the clinical and pharmacological management of children and adolescents with conduct disorder (CD). AREAS COVERED The authors review the CD population and provide a systematic review and meta-analysis of the effectiveness and safety of pharmacotherapies using preferred reporting items for systematic review and meta-analysis (PRISMA) and strength of evidence recommendation taxonomy (SORT) guidelines. The authors then provide an expert clinical opinion for the use of different pharmacotherapies to address aggressive and disruptive behavior in children. EXPERT OPINION Atypical antipsychotics (e.g. risperidone) demonstrate evidence for efficacy in CD. Other pharmacotherapies (e.g. mood stabilizers, anticonvulsants, psychostimulants and selective norepinephrine reuptake inhibitors) have a low level of evidence for CD alone, however, can sometimes be effective in managing the symptoms of CD when other psychiatric disorders are also present.
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Affiliation(s)
- Sohil Khan
- a School of Pharmacy and Pharmacology, Quality Use of Medicines Network, Menzies Health Institute , Griffith University , Gold Coast , Australia.,b Mater Research Institute , The University of Queensland , South Brisbane , Australia.,c Manipal College of Pharmaceutical Sciences , Manipal University , Manipal , India
| | - John Down
- d Children's Health Queensland Hospital and Health Service , Lady Cilento Children's Hospital , South Brisbane , Australia
| | - Nisreen Aouira
- a School of Pharmacy and Pharmacology, Quality Use of Medicines Network, Menzies Health Institute , Griffith University , Gold Coast , Australia
| | - William Bor
- b Mater Research Institute , The University of Queensland , South Brisbane , Australia.,e Child and Youth Mental Health Service , Children's Health Queensland Hospital and Health Service , South Brisbane , Australia.,f Centre for Children's Health Research , Children's Health Queensland Hospital and Health Services , South Brisbane , Australia
| | - Alison Haywood
- a School of Pharmacy and Pharmacology, Quality Use of Medicines Network, Menzies Health Institute , Griffith University , Gold Coast , Australia.,b Mater Research Institute , The University of Queensland , South Brisbane , Australia
| | - Robyn Littlewood
- e Child and Youth Mental Health Service , Children's Health Queensland Hospital and Health Service , South Brisbane , Australia.,f Centre for Children's Health Research , Children's Health Queensland Hospital and Health Services , South Brisbane , Australia.,g School of Human Movement and Nutrition Sciences , The University of Queensland , South Brisbane , Australia
| | - Helen Heussler
- b Mater Research Institute , The University of Queensland , South Brisbane , Australia.,d Children's Health Queensland Hospital and Health Service , Lady Cilento Children's Hospital , South Brisbane , Australia.,f Centre for Children's Health Research , Children's Health Queensland Hospital and Health Services , South Brisbane , Australia
| | - Brett McDermott
- h Townsville Clinical School, College of Medicine and Dentistry , James Cook University , Townsville , Australia
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Ascione FR, McDonald SE, Tedeschi P, Williams JH. The relations among animal abuse, psychological disorders, and crime: Implications for forensic assessment. BEHAVIORAL SCIENCES & THE LAW 2018; 36:717-729. [PMID: 30207616 DOI: 10.1002/bsl.2370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/16/2018] [Accepted: 07/20/2018] [Indexed: 06/08/2023]
Abstract
The confluence of developments in the assessment of animal abuse, the evolution of psychiatric nosology for the diagnosis of conduct disorder, legislative changes involving crimes against non-human animals, and the recent inclusion of crimes against animals in the FBI's National Incident-Based Reporting System, highlights the critical need for examining the forensic dimensions of animal abuse cases. We provide an overview of the research literature on these topics in the hope that forensic evaluators will have an evidence-based framework for assessing cases they encounter that include perpetration of violence against animals.
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Affiliation(s)
- Frank R Ascione
- Graduate School of Social Work, University of Denver, Denver, CO, USA
| | - Shelby E McDonald
- School of Social Work, Virginia Commonwealth University, Richmond, VA, USA
| | - Philip Tedeschi
- Graduate School of Social Work, University of Denver, Denver, CO, USA
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Adult outcomes of conduct problems in childhood or adolescence: further evidence of the societal burden of conduct problems. Eur Child Adolesc Psychiatry 2018; 27:1235-1237. [PMID: 30182351 DOI: 10.1007/s00787-018-1221-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Rincón P, Cova F, Saldivia S, Bustos C, Grandón P, Inostroza C, Streiner D, Bühring V, King M. Effectiveness of a Positive Parental Practices Training Program for Chilean Preschoolers' Families: A Randomized Controlled Trial. Front Psychol 2018; 9:1751. [PMID: 30298035 PMCID: PMC6160552 DOI: 10.3389/fpsyg.2018.01751] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 08/29/2018] [Indexed: 11/29/2022] Open
Abstract
Background: Evidence for the effectiveness of parental training as a strategy for promotion of positive parental practices and prevention of child behavior problems in low and middle income countries is not conclusive. This study aims to assess the effectiveness of a universal positive parental training program designed for this context, “Día a Día” UdeC © (“Day by Day” University of Concepción), in Chilean preschoolers’ families (3–6 years old children). Methods: A cluster randomized controlled trial (cRCT) was carried out in 19 preschool education centers. There were two treatment arms: 10 centers (including 178 families) were randomly assigned to the intervention group and nine centers (including 154 families) were assigned to the waiting list control condition. Intervention groups received Day by Day UdeC, a six group sessions program for parents, including two group sessions for preschool educators, focused in affective communication; daily and child-directed play; directed attention; routines and transitions; reinforcement and incentive programs; planned inattention-ignore and time out; and logical consequences. Parental practices, parental satisfaction, and presence of children behavioral problems were examined at two-time points: T1 (4 weeks before intervention) and T2 (5–6 weeks after intervention). Results: Intention-to-treat analysis shows a reduction in physical punishment and an increase in parental involvement, as well as a reduction in children behavioral problems. A per-protocol analysis revealed an additional effect: increase in observed parental practices. Conclusion: This cRCT provided evidence for the effectiveness of a parental training program for the promotion of positive parental practices in low and middle income countries. The observed effects of the program in decreasing physical punishment and children’s behavioral problems make it a promising strategy for prevention purposes. Trial Registration: This study was registered under ISRCTN.com (ISRCTN90762146; https://doi.org/10.1186/ISRCTN90762146).
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Affiliation(s)
- Paulina Rincón
- Department of Psychology, University of Concepción, Concepción, Chile
| | - Félix Cova
- Department of Psychology, University of Concepción, Concepción, Chile
| | - Sandra Saldivia
- Department of Psychiatry and Mental Health, University of Concepción, Concepción, Chile
| | - Claudio Bustos
- Department of Psychiatry and Mental Health, University of Concepción, Concepción, Chile
| | - Pamela Grandón
- Department of Psychology, University of Concepción, Concepción, Chile
| | - Carolina Inostroza
- Department of Psychology, University of Concepción, Concepción, Chile.,Department of Psychiatry and Mental Health, University of Concepción, Concepción, Chile
| | - David Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Vasily Bühring
- Department of Psychology, University of Concepción, Concepción, Chile
| | - Michael King
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
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12
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Holz NE, Zohsel K, Laucht M, Banaschewski T, Hohmann S, Brandeis D. Gene x environment interactions in conduct disorder: Implications for future treatments. Neurosci Biobehav Rev 2018; 91:239-258. [DOI: 10.1016/j.neubiorev.2016.08.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 07/27/2016] [Accepted: 08/15/2016] [Indexed: 01/30/2023]
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13
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Hambly JL, Francis K, Khan S, Gibbons KS, Walsh WJ, Lambert B, Testa C, Haywood A. Micronutrient Therapy for Violent and Aggressive Male Youth: An Open-Label Trial. J Child Adolesc Psychopharmacol 2017; 27:823-832. [PMID: 28481642 DOI: 10.1089/cap.2016.0199] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Pharmacotherapy for problematic aggressive and violent behavior disorders in male children and adolescents is associated with significant adverse events. Treatments with more acceptable risk-benefit ratios are critically needed. Micronutrient intervention will be investigated as an alternative to bridge the therapeutic gap in the management of these behaviors. METHODS Males aged 4-14 who displayed ongoing violent and aggressive behaviors received micronutrient intervention containing alpha-tocopherol (vitamin E), ascorbic acid (vitamin C), biotin, chromium, pyridoxal-5-phosphate (P5P), pyridoxine (vitamins B6), selenium, and zinc, in a 16-week open-label trial. Plasma zinc, plasma copper, copper/zinc ratio, and urinary hydroxyhemopyrroline-2-one (HPL) tests were conducted at baseline and endpoint. Participants were examined for changes in aggressive and violent behaviors measured using the Children's Aggression Scale (CAS) and the Modified Overt Aggression Scale (MOAS), improvements in family functioning measured using the Family Functioning Style Scale, improvements in health-related quality of life (HRQoL) measured using the Pediatric Quality of Life Inventory (PedsQL) at baseline, 8 weeks, endpoint, and at 4-6-month follow-up. RESULTS Thirty-two male children and adolescents met inclusion criteria. Thirty-one (mean 8.35 ± standard deviation 2.93 years) completed the study, with one participant lost to follow-up. Micronutrient therapy significantly improved parent-reported aggressive and violent behaviors measured using the CAS for all domains except the use of weapons (p < 0.001 to p = 0.02) with medium to large effect size (Cohen's d = 0.72-1.43) and the MOAS (p < 0.001) with large effect size (Cohen's d = 1.26). Parent-reported HRQoL (p < 0.001; Cohen's d = -1.69) and family functioning (p = 0.03; Cohen's d = -0.41) also significantly improved. CONCLUSION Micronutrient therapy appeared well tolerated, with a favorable side effect profile. It appeared effective in the reduction of parent-reported aggressive and violent behaviors, and showed improvement in family functioning and HRQoL in male youth after 16 weeks. Further research in the form of a double-blinded, randomized controlled trial is required to verify these initial positive observations.
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Affiliation(s)
- Jessica L Hambly
- 1 School of Pharmacy, Menzies Health Institute Queensland, Griffith University , Southport, Australia
| | - Kelly Francis
- 2 Happiness in Health , West Burleigh, Queensland, Australia
| | - Sohil Khan
- 1 School of Pharmacy, Menzies Health Institute Queensland, Griffith University , Southport, Australia .,3 Mater Research Institute-The University of Queensland , Brisbane, Queensland, Australia
| | - Kristen S Gibbons
- 3 Mater Research Institute-The University of Queensland , Brisbane, Queensland, Australia
| | | | - Brett Lambert
- 5 Applied Analytical Laboratories , Meadowbrook, Queensland, Australia
| | - Chris Testa
- 6 Chris Testa's Tugun Compounding Pharmacy , Tugun, Queensland, Australia
| | - Alison Haywood
- 1 School of Pharmacy, Menzies Health Institute Queensland, Griffith University , Southport, Australia .,3 Mater Research Institute-The University of Queensland , Brisbane, Queensland, Australia
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14
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Kennedy EMM, French L, Roberts C. Personalised interventions for subgroups of children with conduct problems. Hippokratia 2017. [DOI: 10.1002/14651858.cd012746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Eilis M M Kennedy
- Tavistock Clinic; Children, Young Adults and Families Department; 120 Belsize Lane Hampstead London UK NW3 5BA
- University College London; Research Department of Clinical, Educational and Health Psychology; London UK
| | - Lorna French
- Tavistock Clinic; Children, Young Adults and Families Department; 120 Belsize Lane Hampstead London UK NW3 5BA
| | - Christopher Roberts
- University of Manchester; Division of Population Health; Jean McFarlane Building Oxford Road Manchester UK M3 9PL
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15
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Mihara S, Higuchi S. Cross-sectional and longitudinal epidemiological studies of Internet gaming disorder: A systematic review of the literature. Psychiatry Clin Neurosci 2017; 71:425-444. [PMID: 28436212 DOI: 10.1111/pcn.12532] [Citation(s) in RCA: 310] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/13/2017] [Accepted: 04/16/2017] [Indexed: 12/16/2022]
Abstract
AIM The diagnostic criteria of Internet gaming disorder (IGD) have been included in section III of DSM-5. This study aims to systematically review both cross-sectional and longitudinal epidemiological studies of IGD. METHODS All publications included in PubMed and PsychINFO up to May 2016 were systematically searched to identify cross-sectional studies on prevalence and longitudinal studies of IGD. In the process of identification, articles in non-English languages and studies focusing solely on the use of gaming were excluded, and those meeting the methodological requirements set by this review were included. As a result, 37 cross-sectional and 13 longitudinal studies were selected for review. RESULTS The prevalence of IGD in the total samples ranged from 0.7% to 27.5%. The prevalence was higher among males than females in the vast majority of studies and tended to be higher among younger rather than older people in some studies. Geographical region made little difference to prevalence. Factors associated with IGD were reported in 28 of 37 cross-sectional studies. These were diverse and covered gaming, demographic and familial factors, interpersonal relations, social and school functioning, personality, psychiatric comorbidity, and physical health conditions. Longitudinal studies identified risk and protective factors, and health and social consequences of IGD. The natural course of IGD was diverse but tended to be more stable among adolescents compared to adults. CONCLUSION Although existing epidemiological studies have provided useful data, differences in methodologies make it difficult to compare the findings of these studies when drawing consensus. Future international studies using reliable and uniform methods are warranted.
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Affiliation(s)
- Satoko Mihara
- Department of Psychiatry, National Hospital Organization Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Susumu Higuchi
- Department of Psychiatry, National Hospital Organization Kurihama Medical and Addiction Center, Yokosuka, Japan
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16
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Exploring possible association between DβH genotype (C1021T), early onset of conduct disorder and psychopathic traits in juvenile delinquents. Eur Arch Psychiatry Clin Neurosci 2016; 266:771-773. [PMID: 26616837 DOI: 10.1007/s00406-015-0664-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022]
Abstract
Early onset of conduct disorder (CD) with callous-unemotional traits has been linked to low levels of dopamine β-hydroxylase (DβH), an enzyme involved in dopamine turnover. The C1021T polymorphism in the DβH gene is a major quantitative-trait locus, regulating the level of DβH. In this study of juvenile delinquents from Northern Russia (n = 180), the polymorphism at -1021 was associated neither with early-onset CD nor with psychopathic traits. Association was found between psychopathic traits and early-onset CD, ADHD and mania.
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17
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Hambly JL, Khan S, McDermott B, Bor W, Haywood A. Pharmacotherapy of conduct disorder: Challenges, options and future directions. J Psychopharmacol 2016; 30:967-75. [PMID: 27436231 DOI: 10.1177/0269881116658985] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED There is a critical need for evaluation of the pharmacotherapies used in conduct disorder (CD), due to the high incidence of off-label prescribing. The aim of this review was to identify concerns associated with the safety, efficacy and impact on quality of life (QOL) that pharmacotherapy has in children and adolescents with CD. A systematic review was undertaken using pre-defined search criteria and four databases, including reference searches. We assessed these studies using the Strength of Recommendation Taxonomy, Grading of Recommendations Assessment, Development and Evaluation, and Review Manager Risk of Bias (RevMan®) tools. There were 12 randomised controlled trials that met our inclusion criteria. STUDIES INCLUDED antipsychotics, atomoxetine, lithium, clonidine, divalproex sodium and psychostimulants. The antipsychotics demonstrated efficacy, but were associated with adverse effects. Other agents demonstrated mixed responses, highlighting the lack of clinical significance and increased incidence of adverse effects. The management of related adverse effects was addressed to assist with clinical gaps. Overall, there is limited evidence regarding the role of pharmacotherapy in CD. More research is needed that takes into account the heterogeneity of CD and analysis of pharmacotherapy in pure CD.
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Affiliation(s)
- Jessica L Hambly
- School of Pharmacy, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Sohil Khan
- School of Pharmacy, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia Mater Research Institute - The University of Queensland, Brisbane, QLD, Australia Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, India
| | - Brett McDermott
- Townsville Clinical School, College of Medicine and Dentistry, James Cook University, Queensland, QLD, Australia
| | - William Bor
- Mater Research Institute - The University of Queensland, Brisbane, QLD, Australia Child and Youth Mental Health Service, Centre for Children's Health Research, Queensland Health, Brisbane, QLD, Australia
| | - Alison Haywood
- School of Pharmacy, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia Mater Research Institute - The University of Queensland, Brisbane, QLD, Australia
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18
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Jambroes T, Jansen LMC, Vermeiren RRJM, Doreleijers TAH, Colins OF, Popma A. The clinical usefulness of the new LPE specifier for subtyping adolescents with conduct disorder in the DSM 5. Eur Child Adolesc Psychiatry 2016; 25:891-902. [PMID: 26725044 DOI: 10.1007/s00787-015-0812-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 11/14/2015] [Indexed: 10/22/2022]
Abstract
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.
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Affiliation(s)
- Tijs Jambroes
- Department of Child and Adolescent Psychiatry, VU University Medical Center, c/o De Bascule, P.O. Box 303, 1115 ZG, Duivendrecht, The Netherlands.
| | - Lucres M C Jansen
- Department of Child and Adolescent Psychiatry, VU University Medical Center, c/o De Bascule, P.O. Box 303, 1115 ZG, Duivendrecht, The Netherlands
| | - Robert R J M Vermeiren
- Department of Child and Adolescent Psychiatry, VU University Medical Center, c/o De Bascule, P.O. Box 303, 1115 ZG, Duivendrecht, The Netherlands.,Department of Child and Adolescent Psychiatry, Curium-LUMC, Leiden University Medical Center, Leiden, The Netherlands
| | - Theo A H Doreleijers
- Department of Child and Adolescent Psychiatry, VU University Medical Center, c/o De Bascule, P.O. Box 303, 1115 ZG, Duivendrecht, The Netherlands
| | - Olivier F Colins
- Department of Child and Adolescent Psychiatry, Curium-LUMC, Leiden University Medical Center, Leiden, The Netherlands
| | - Arne Popma
- Department of Child and Adolescent Psychiatry, VU University Medical Center, c/o De Bascule, P.O. Box 303, 1115 ZG, Duivendrecht, The Netherlands.,Faculty of Law, Leiden University, Leiden, The Netherlands
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19
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Prenatal Exposure to Perfluoroalkyl Substances and Behavioral Development in Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13050511. [PMID: 27213416 PMCID: PMC4881136 DOI: 10.3390/ijerph13050511] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 04/28/2016] [Accepted: 05/09/2016] [Indexed: 01/09/2023]
Abstract
Background: In recent years, prevalence rates of behavioral disorders in children have increased. One factor possibly implied in the etiology of behavioral disorders is exposure to perfluoroalkyl substances (PFASs). The use of PFASs is highly integrated into everyday life, and exposure is ubiquitous. Exposure to PFASs during early life may be particularly harmful, as it represents a critical time window for brain development. However, research in the area is limited, especially among preschool children. The objective of the current study was to explore the relationship between prenatal exposure to several PFASs and behavioral development at the age of 18 months. Methods: Data from the Dutch cohort LINC (Linking Maternal Nutrition to Child Health) were used. Perfluorooctanesulfonic acid (PFOS) and perfluorooctanoic acid (PFOA) were measured in cord plasma. The total exposure of PFASs was also calculated (ΣPFASs). Behavioral development was assessed with the Child Behavior Checklist 1.5–5 (CBCL 1.5–5). The CBCL scales “Attention Deficit Hyperactivity Disorder” (ADHD) and “Externalizing problems” were used for further analysis. Separate regression models were composed for each combination, in which exposure levels were classified in tertiles. Both whole population and sex-stratified analyses were performed. A family history of ADHD, the educational level, smoking or using alcohol or illicit drugs during pregnancy were considered as confounders. In total, data from 76 mother-child pairs was included. Results: No significant associations were found between prenatal PFAS exposure and ADHD scores in the whole population and in the sex-stratified analyses. With regard to externalizing behavior, a significant negative association was found between the highest levels of ΣPFAS exposure and externalizing problem behavior in the whole population, but only in the crude model. After stratifying for sex, boys in the second and third tertile of exposure to PFOA presented significantly lower scores on the Externalizing Problem Scale than boys with the lowest exposure levels in the adjusted model. Girls exposed to higher levels of ΣPFAS exposure (T2) showed significantly lower scores on the Externalizing Problem Scale, in both crude and adjusted models. No significant associations with PFOS were found. Conclusions: Results from the current study show that prenatal exposure to PFOA was negatively related to externalizing behavior in boys. Results were different for boys and girls, emphasizing that mechanisms at work might be sex-dependent. However, results should be interpreted with caution as the sample size was small.
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20
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Wilkinson S, Waller R, Viding E. Practitioner Review: Involving young people with callous unemotional traits in treatment--does it work? A systematic review. J Child Psychol Psychiatry 2016; 57:552-65. [PMID: 26686467 DOI: 10.1111/jcpp.12494] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Children and adolescents with callous unemotional (CU) traits are at risk of severe and persistent antisocial behavior. It is commonly assumed that these children are difficult to treat but it has been proposed that they may benefit from being involved in interventions that go beyond typical parent training programs. This systematic review sought to answer two previously unanswered questions: do interventions involving young people reduce levels of CU traits? Do CU traits predict the effectiveness of interventions for antisocial behavior involving young people? METHOD Studies were included that adopted an randomized controlled trial, controlled or open trial design and that had examined whether treatment was related to reductions in CU traits or whether CU traits predicted or moderated treatment effectiveness. RESULTS Treatments used a range of approaches, including behavioral therapy, emotion recognition training, and multimodal interventions. 4/7 studies reported reductions in CU traits following treatment. There was a mixed pattern of findings in 15 studies that examined whether CU traits predicted treatment outcomes following interventions for antisocial behavior. In 7/15 studies, CU traits were associated with worse outcomes, although three of these studies did not provide data on baseline antisocial behavior, making it difficult to evaluate whether children with high CU traits had shown improvements relative to their own behavioral baseline, despite having the worst behavioral outcomes overall. CU traits did not predict outcomes in 7/15 studies. Finally, a single study reported that CU traits predicted an overall increased response to treatment. CONCLUSIONS Overall, the evidence supports the idea that children with CU traits do show reductions in both their CU traits and their antisocial behavior, but typically begin treatment with poorer premorbid functioning and can still end with higher levels of antisocial behavior. However, there is considerable scope to build on the current evidence base.
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Affiliation(s)
- Simon Wilkinson
- Department of Child and Adolescent Mental Health, Great Ormond Street & Royal London Higher Training Scheme, London, UK
| | - Rebecca Waller
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Essi Viding
- Division of Psychology and Language Sciences, University College London, London, UK
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21
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Masi G, Milone A, Manfredi A, Brovedani P, Pisano S, Muratori P. Combined pharmacotherapy-multimodal psychotherapy in children with Disruptive Behavior Disorders. Psychiatry Res 2016; 238:8-13. [PMID: 27086204 DOI: 10.1016/j.psychres.2016.02.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/15/2015] [Accepted: 02/08/2016] [Indexed: 11/16/2022]
Abstract
Although multi-component psychotherapeutic interventions are first-line treatments for Disruptive Behavior Disorders (DBD), pharmacotherapy is often associated for more severe patients. Our aim was to explore effectiveness of an associated pharmacotherapy in referred children with DBD receiving a one-year psychotherapeutic intervention. Aggression, callous unemotional (CU) traits and emotional dysregulation were outcome measures. The sample included 144 children, aged 8-12 years, 41 (29%) with an ADHD comorbidity. Fifty-five (38%) patients received an additional pharmacotherapy with one medication, methylphenidate, a second generation antipsychotic, or a mood stabilizer. Data were collected before and after the one-year treatment. According to the Child Behavior Checklist (CBCL), aggressive behaviors, rule-breaking behaviors and emotional dysregulation improved in the whole group, as well as parent- and child-reported CU traits. The hierarchical regression model showed that additional pharmacotherapy significantly predicted lower scores at the CBCL aggressive behaviors and emotional dysregulation, but not CU traits at the end of the treatment. The interaction between methylphenidate and ADHD comorbidity predicted lower aggressive behaviors after the treatment. In summary, this naturalistic investigation suggest that an additional pharmacotherapy significantly improved aggression and emotional dysregulation, but not CU traits. When ADHD was comorbid, methylphenidate was more effective than antipsychotics or mood stabilizers in reducing aggression.
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Affiliation(s)
- Gabriele Masi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy.
| | - Annarita Milone
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Azzurra Manfredi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Paola Brovedani
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Simone Pisano
- Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Psychiatry Division, Second University of Naples, Italy
| | - Pietro Muratori
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
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22
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Klahr AM, Klump KL, Burt SA. The etiology of the association between child antisocial behavior and maternal negativity varies across aggressive and non-aggressive rule-breaking forms of antisocial behavior. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2015; 42:1299-311. [PMID: 24906982 DOI: 10.1007/s10802-014-9886-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
There is a robust association between negative parenting and child antisocial behavior problems. However, the etiology of this association remains unclear. Extant literature has reported strikingly different conclusions across studies, with some highlighting genetic mediation and others highlighting environmental mediation. One possible reason for these discrepancies across studies may be the failure to differentiate between aggressive and non-aggressive (rule-breaking) dimensions of childhood antisocial behavior, given their notably different etiologies and developmental trajectories (Burt 2012). The current study sought to examine the phenotypic and etiologic associations of maternal negativity with aggressive and rule-breaking antisocial behavior, respectively. Participants included 824 mothers and their twin children between the ages of 6 and 10. Our results highlighted clear etiologic distinctions in the associations of aggression and rule-breaking with maternal negativity. Aggression was associated with maternal negativity via both genetic and environmental factors, whereas the association between non-aggressive rule-breaking and maternal negativity was entirely environmental in origin. These findings provide additional support for the presence of meaningful distinctions between aggressive and non-aggressive forms of antisocial behavior, and highlight the complex relationship between parenting and child outcome.
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Affiliation(s)
- Ashlea M Klahr
- Department of Psychology, Michigan State University, East Lansing, MI, 48824, USA,
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23
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Sadhu J. Childhood Precursors to Psychopathy. Psychiatr Ann 2015. [DOI: 10.3928/00485713-20150401-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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24
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Scott S. Something old, something new: reflections on behavioural heterogeneity in conduct disorders and Klahr & Burt (2014). J Child Psychol Psychiatry 2014; 55:1311-3. [PMID: 25307184 DOI: 10.1111/jcpp.12345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Stephen Scott
- King's College London, Institute of Psychiatry and National Academy for Parenting Research, London, UK
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