Heritable Composite Phenotypes Defined by Combinations of Conduct Problem, Depression, and Temperament Features: Contributions to risk for Alcohol Problems

The genetic architectures underlying symptoms of conduct problems and depression have largely been examined separately and without incorporating temperament, despite evidence for their genetic overlap. We examined how symptoms and temperament dimensions were transmitted together in families to identify highly heritable composite phenotypes, and how these composite phenotypes predicted alcohol outcomes in young adulthood. Participants (N = 486) were drawn from the third generation of families oversampled for alcohol use disorder in the first generation. Conduct problems, depression, and temperament were reported at 11-19 years old and alcohol outcomes at 18-26 years old. Using principal components of heritability analysis, we found seven highly heritable composite phenotypes, five of which predicted alcohol outcomes: three characterized by co-occurring conduct problems and depression and two by conduct problems. Novel composite phenotypes that were characterized by both conduct problems and depression showed different types of symptoms, temperament features, and genetic underpinnings. Children manifesting differing composite phenotypes might benefit from distinct treatments based on their unique etiologies.

Proposed Specifiers for Conduct Disorder (PSCD) scale: A Latent Profile Analysis with At-Risk Adolescents

The Proposed Specifiers for Conduct Disorder (PSCD; Salekin in Pers Disord: Theory Res Treat 7:180-191, 2016) scale was designed to assess interrelated psychopathic trait domains in conjunction with symptoms of Conduct Disorder (CD) in children and adolescents (i.e., grandiose-manipulative, callous-unemotional, daring-impulsive). Variable-centered studies have provided support for a four-factor PSCD structure (Salekin et al. in Psychol Assess 34(10):985-992, 2022) in line with other adolescent and adult studies. The current person-centered study used latent profile analysis of the PSCD domains to examine whether theoretically meaningful and empirically robust PSCD subtypes emerged from a diverse sample (70.9% White, 20.1% Black, 3.6% Hispanic, and 5.4% other) of adolescents (modal age = 17) in a military style residential facility (N = 409; Males = 80.6%). As hypothesized, a four-class solution was best, consistent with adult psychopathy subtyping research (Hare et al. in Handbook of Psychopathy 39-79, 2018; Roy et al. in Pers Disord: Theory Res Treat, in press). The PSCD subtype profiles were uniform across sex and race/ethnicity. Adolescents evincing a psychopathic trait propensity profile (elevated on all four PSCD domains) displayed the greatest number of arrests and higher overall externalizing psychopathology, compared to the other three latent classes, as well as higher internalizing psychopathology compared to adolescents with general delinquency. The PSCD provides a sound measure of psychopathic trait propensities in youth and our results offer investigators and clinicians a means for understanding person-centered psychopathic traits versus antisocial profiles among at-risk adolescents. Taken together, the current results may offer a viable approach for examining specific treatment targets based on PSCD subtype profiles.

Novel Oppositional Defiant Disorder or Conduct Disorder 24 Months After Traumatic Brain Injury in Children and Adolescents

OBJECTIVE

The authors sought to identify predictive factors of new-onset or novel oppositional defiant disorder or conduct disorder assessed 24 months after traumatic brain injury (TBI).

METHODS

Children ages 5 to 14 years who had experienced TBI were recruited from consecutive hospital admissions. Soon after injury, participants were assessed for preinjury characteristics, including psychiatric disorders, socioeconomic status (SES), psychosocial adversity, and family function, and the presence and location of lesions were documented by MRI. Psychiatric outcomes, including novel oppositional defiant disorder or conduct disorder, were assessed 24 months after injury.

RESULTS

Of the children without preinjury oppositional defiant disorder, conduct disorder, or disruptive behavior disorder not otherwise specified who were recruited in this study, 165 were included in this sample; 95 of these children returned for the 24-month assessment. Multiple imputation was used to address attrition. The prevalence of novel oppositional defiant disorder or conduct disorder was 23.7 out of 165 (14%). In univariable analyses, novel oppositional defiant disorder or conduct disorder was significantly associated with psychosocial adversity (p=0.049) and frontal white matter lesions (p=0.016) and was marginally but not significantly associated with SES. In the final multipredictor model, frontal white matter lesions were significantly associated with novel oppositional defiant disorder or conduct disorder (p=0.021), and psychosocial adversity score was marginally but not significantly associated with the outcome. The odds ratio of novel oppositional defiant disorder or conduct disorder among the children with versus those without novel depressive disorder was significantly higher for girls than boys (p=0.025), and the odds ratio of novel oppositional defiant disorder or conduct disorder among the children with versus those without novel attention-deficit hyperactivity disorder (ADHD) was significantly higher for boys than girls (p=0.006).

CONCLUSION

Approximately 14% of children with TBI developed oppositional defiant disorder or conduct disorder. The risk for novel oppositional defiant disorder or conduct disorder can be understood from a biopsychosocial perspective. Sex differences were evident for comorbid novel depressive disorder and comorbid novel ADHD.

Testing Three New Scoring Methods to Identify Detained Adolescent Girls with Elevated Levels of Callous-Unemotional Traits

Different scoring methods have been proposed to identify adolescents with high levels of callous-unemotional (CU) traits as measured by the Inventory of Callous-Unemotional traits (ICU). This is the first study to scrutinize the usefulness of the normative, empirical, and DSM-5 with Limited Prosocial Emotions (LPE) scoring methods in criminal justice-involved girls (N = 192). Girls (Mage = 15.74) completed the ICU and other self-report questionnaires. A diagnostic interview was used to determine the presence of conduct disorder (CD) and other psychiatric disorders. Official arrest and rearrest data were also collected. The three scoring methods designated girls with (versus without) CU traits who scored higher on various indices of past and future antisocial behavior, exhibited higher rates of (childhood-onset) CD and higher levels of psychopathic traits, and displayed lower levels of agreeableness and conscientiousness. It was only when the normative and empirical scoring methods were applied that girls with CU traits had higher rates of substance use disorders and were less anxious, depressed, and/or neurotic. In a subsample of girls with CD (N = 119), the three scoring methods captured a more severely antisocial subgroup. Other expected group differences emerged, though mainly when the normative scoring method was used. Results provided support for the clinical utility of the three scoring methods but also showed that the normative scoring method most aligns with theoretical expectations. Research is warranted to explore if this normative scoring method serves as a better categorically-defined specifier for CD than the specifier that is incorporated in the DSM-5.

Deficits in Parent Knowledge of Behavior Management Skills is Strongly Associated with CD Symptoms but Not ODD Symptoms

We conducted secondary analyses of existing data to examine the association between parent scores on the Knowledge of Effective Parenting Test (KEPT) and child symptoms of Conduct Disorder (CD) and Oppositional Defiant Disorder (ODD). Parent knowledge of behavior management skills and child behavior symptoms were assessed in a nationally representative sample of parents/guardians (N = 1,570) of children aged 5-12 from all 50 states. Results showed consistent and robust correlations between parent knowledge of behavior management skills and CD symptoms but not ODD symptoms. These findings suggest that parent knowledge of behavior management may be a greater risk factor for CD than ODD, with implications for taxonomy and understanding the etiology of these two disorders. We also discuss the implications of these findings for the prevention and treatment of these two disorders which are often grouped together in treatment trials.

Proposed Specifiers for Conduct Disorder (PSCD): Factor Structure and Validation of the Self-Report Version in Community and Forensic Samples of Portuguese Youth

The Proposed Specifiers for Conduct Disorder (PSCD) was developed as a measure to assess the multifaceted model of psychopathic traits in children/youth (i.e., grandiose-manipulative [GM], callous-unemotional [CU], and daring-impulsive [DI] traits) in addition to Conduct Disorder (CD) symptoms. This study aims to test the psychometric properties of the PSCD-self-report version across community (n = 648; 52.9% female) and forensic male youth (n = 258) from the Portuguese population. Results supported a general factor and four specific factors (GM, CU, DI, CD), which was invariant across gender and sample type. Evidence for reliability, construct, and temporal validity were also found. Overall, the PSCD appears to be a promising measure for assessing psychopathic traits in youth from both community and forensic settings, which may contribute to the discussion around the conceptualization, assessment, predictive value, and clinical usefulness of the multifaceted model of psychopathy in youthful populations, particularly in its association with CD.

The Global Prevalence of Conduct Disorder: A Systematic Review and Meta-Analysis

Objective: There has been little effort to conduct systematic reviews or meta-analyses of the available literature to find global prevalence rates of conduct disorder and analyze the sources of heterogeneity. Method : We searched multiple databases, including Web of Science, PubMed, Scopus, and Google Scholar to identify cross-sectional studies with random or nonrandom sampling to assess the global prevalence of conduct disorder in children and adolescents aged under 18 in the general or school-based populations. Quality assessment and data extraction were independently carried out by two authors. Subgroup analysis was used to find the potential sources of heterogeneity. Results: We reached 50 studies, incorporating 186,056 children and adolescents from 35 countries. The total prevalence of conduct disorder was 8% (CI: 7-9%; I2: 99.77%), including 7% in females (CI: 4-9%; I2: 99.56%) and 11% in males (CI: 7-15%; I2: 99.74%). The results of subgroup analysis showed that total heterogeneity could be explained by measurement tools. When diagnostic interviews such as the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL) and Development and Well-Being Assessment (DAWBA) were employed, the pooled prevalence rates for conduct disorder were 0.4% and 0.7%, respectively, and heterogeneity decreased. However, the use of the screening tools such as the Strengths and Difficulties Questionnaire (SDQ)-parent or teacher report and SDQ-self report increased the pooled prevalence of conduct disorder to 10% and 16% respectively. Conclusion: The prevalence of conduct disorder in the epidemiological studies should be estimated by employing the diagnostic interviews to reach accurately assessments.

Neural Responses to Signals for Behavior Change: Greater Within-Person Variability is Associated With Risk Factors for Substance Dependence

BACKGROUND

An impaired ability to change behavior in the face of cues indicating a need for change is one means of defining risk for substance dependence. The present study used a cognitive task administered in a laboratory as a model of this process. It focused on 2 known and related correlates of risk (conduct disorder, borderline personality disorder) and examined their associations with reactivity to cues requesting a change in motor behavior.

METHODS

A total of 224 teenagers, 14 to 19 years of age, performed a task during which white noise bursts were used to cue a requirement to reverse the mapping of right and left key press responses onto high- and low-frequency pure tones during a subsequent trial block. The amplitude of the P300 electroencephalographic (EEG) response to each cue was summarized by calculating its across-trial average as well as its intertrial variability (ITV). In addition, the number of motor response reversal failures (perseveration errors) was calculated.

RESULTS

The ITV of the P300 response to cues for behavior change was superior to its average amplitude in revealing associations with risk: It was significantly greater among teenagers with more conduct problems and more borderline personality disorder symptoms in comparison with their less-affected peers. ITV was also positively correlated with perseveration errors. No group differences were found in P300 amplitude averaged over trials.

CONCLUSIONS

The findings suggest that the measurement of intertrial variability in brain activity may be more valuable than the average level for revealing neurophysiological differences associated with impulsivity and personality risk factors for dependence. EEG measures may be particularly valuable in this context because they offer superior temporal resolution and signal-to-noise characteristics.

Do behavioral disorders render gang status spurious? New insights

In community and correctional settings, gang status is a robust predictor of offending, unfortunately relatively few studies have considered behavioral disorders of offenders and whether these disorders mediate the gang-offending relationship. Drawing on a near population of correctional clients on federal supervised release, negative binomial regression and ROC-AUC models found that gang variables were rendered insignificant or were generally weak classifiers of severe offending once behavioral disorders were specified. The only exception was security threat group status that was robustly associated with prison misconduct. Gang researchers should consider behavioral disorders and other psychopathology of gang members to inform theory and research.

The processing of animacy information is disrupted as a function of callous-unemotional traits in youth with disruptive behavior disorders

Atypical amygdala responses to emotional stimuli have been consistently reported in youth with Disruptive Behavior Disorders (DBDs; Conduct Disorder/Oppositional Defiant Disorder). However, responding to animacy stimuli has not been systematically investigated. Yet, the amygdala is known to be responsive to animacy stimuli and impairment in responsiveness to animacy information may have implications for social cognitive development. Twenty-nine youth with DBDs and 20 typically developing youth, matched for IQ, age (M_age = 14.45, SD = 2.05) and gender, completed a dot probe task during fMRI. Stimuli consisted of negative/faces, negative/objects, neutral/faces and neutral/objects images. Youth with DBDs, relative to typically developing youth, showed: i) reduced amygdala and lateral temporal cortex responses to faces relative to objects. Moreover, within the group of youth with DBDs, increasing callous-unemotional traits were associated with lesser amygdala responses to faces relative to objects. These data suggest that youth with DBDs, particularly those with high levels of CU traits exhibit dysfunction in animacy processing in the amygdala. This dysfunction may underpin the asociality reported in these youth.

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Animacy processing within the amygdala is a critical component of social cognition.

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Youth with DBDs had reduced responses to faces compared to objects in amygdala.

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CU traits were associated with reduced amygdala responses to faces.

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Youth with DBDs, particularly those with CU exhibit problems in animacy processing.

Locus-specific DNA methylation changes and phenotypic variability in children with attention-deficit hyperactivity disorder

Maternal smoking during pregnancy is the most commonly cited risk factor for ADHD. While the causal relation between this factor and ADHD is debated, several lines of evidence suggest that it modulates the severity of ADHD, particularly through higher association with conduct disorder (CD). We hypothesized that maternal smoking during pregnancy may be associated with differential methylation in selected genes in children with ADHD. DNA extracted from peripheral blood was used to examine methylation between 25 children exposed, and 22 children not exposed to maternal smoking during pregnancy. Three genes (AHRR, CYP1A1, GFI1) were selected based on previous results observed in the general population. Regression analysis was conducted between methylation levels in these candidate genes and: (a) total number of ADHD and CD symptoms; (b) birth weight. Significant differences in methylation were observed in each of the candidate genes between children exposed and not exposed to maternal smoking during pregnancy. Methylation at the selected sites showed significant association with specific phenotypes. Significant correlations were observed between methylation within AHRR and number of CD symptoms; GFI1 and number of ADHD symptoms and GFI1 and birth weight. These initial results may have important clinical implications if confirmed in a larger independent sample.

Spiritual Psychotherapy for Adolescents with Conduct Disorder: Designing and Piloting a Therapeutic Package

Objective: Spiritual psychotherapy has been conceptualized in the context of love and belief as principles of existence. Spiritual psychotherapy can provide an opportunity to design programs to treat conduct disorder. The aim of this study was to introduce the Spiritual Psychotherapy Package for Adolescents with Conduct Disorder and execute it as a pilot study. Method: The intervention is a manual-guided program conducted over 14 group sessions, using the perspectives of object relations and attachment approach. It was executed for a group of eight adolescent boys with conduct disorder (mean age: 17.01 years) at Tehran reformatory. The Aggression Questionnaire and the Attachment to God Inventory were completed pre- and post-intervention. Results: There were no significant differences in outcome measures from pre- to post- intervention. Cohen's dav was applied to estimate the measure of the effect size in this study. Cohen's dav measures of avoidance and anxious attachment to God showed acceptable effect sizes. However, Cohen's dav measure of verbal aggression indicated a small effect size. Conclusion: We found evidence indicating acceptability of spiritual psychotherapy among adolescents with conduct disorder in attachment to God.

Age of Drinking Initiation as a Risk Factor for Alcohol Use Disorder Symptoms is Moderated by ALDH2*2 and Ethnicity

BACKGROUND

An early age of drinking initiation (ADI) has been associated with increased risk for alcohol use disorders (AUDs), but the consistency of this risk across diverse samples has not been well studied. The purpose of this study was to examine whether the pathway from ADI to AUD symptoms by early adulthood is moderated by ethnicity and possessing an alcohol-metabolizing gene ALDH2*2 variant allele.

METHODS

We used multigroup structural equation modeling, including 5 groups split by ethnicity and ALDH2*2, to examine the consistency of the path from ADI to AUD symptoms in 604 Chinese-, Korean-, and White-American college students. We further examined the effects of ALDH2*2, ethnicity, and their interaction in Asians to better understand their unique contributions to the moderation.

RESULTS

The association between ADI and AUD symptoms was moderated, with ADI negatively associated with AUD symptoms among Koreans without ALDH2*2 and Whites, but not among Koreans with ALDH2*2 or Chinese regardless of ALDH2*2. Both ALDH2*2 and ethnicity within Asians contributed unique variability in the effect.

CONCLUSIONS

Ethnicity and ALDH2*2 altered the relationship of ADI as a risk factor for AUD symptoms. Being Chinese and possessing an ALDH2*2 allele within Koreans both buffered against the risk for AUD symptoms associated with earlier ADI, indicating that this relationship can be attenuated by protective factors.

Psychosocial Stress and Brain Function in Adolescent Psychopathology

OBJECTIVE

The authors sought to explore how conduct, hyperactivity/inattention, and emotional symptoms are associated with neural reactivity to social-emotional stimuli, and the extent to which psychosocial stress modulates these relationships.

METHOD

Participants were community adolescents recruited as part of the European IMAGEN study. Bilateral amygdala regions of interest were used to assess the relationship between the three symptom domains and functional MRI neural reactivity during passive viewing of dynamic angry and neutral facial expressions. Exploratory functional connectivity and whole brain multiple regression approaches were used to analyze how the symptoms and psychosocial stress relate to other brain regions.

RESULTS

In response to the social-emotional stimuli, adolescents with high levels of conduct or hyperactivity/inattention symptoms who had also experienced a greater number of stressful life events showed hyperactivity of the amygdala and several regions across the brain. This effect was not observed with emotional symptoms. A cluster in the midcingulate was found to be common to both conduct problems and hyperactivity symptoms. Exploratory functional connectivity analyses suggested that amygdala-precuneus connectivity is associated with hyperactivity/inattention symptoms.

CONCLUSIONS

The results link hyperactive amygdala responses and regions critical for top-down emotional processing with high levels of psychosocial stress in individuals with greater conduct and hyperactivity/inattention symptoms. This work highlights the importance of studying how psychosocial stress affects functional brain responses to social-emotional stimuli, particularly in adolescents with externalizing symptoms.

Co-Occurrence of ODD and CD in Preschool Children With Symptoms of ADHD

OBJECTIVE

Patterns of co-occurrence between ADHD, Oppositional Defiant Disorder (ODD), and Conduct Disorder (CD) were examined in a sample of non-referred preschool children. ADHD subtypes and sex differences were also explored.

METHOD

Children aged 3.5 years ( n = 1,048) with high scores on ADHD characteristics were recruited from the Norwegian Mother and Child Cohort Study and clinically assessed, including a semi-structured psychiatric interview.

RESULTS

In children with ADHD, concurrent ODD was present more often than CD (31% vs. 10%), but having ADHD gave higher increase in the odds of CD than of ODD (ODD: odds ratio [OR] = 6.7, 95% confidence interval [CI] = [4.2, 10.8]; CD: OR = 17.6, 95% CI = [5.9, 52.9]). We found a greater proportion of children having the combined ADHD subtype as well as more severe inattentiveness among children with co-occurring CD compared with ODD. Sex differences were minor.

CONCLUSION

There are important differences in co-occurring patterns of ODD and CD in preschool children with ADHD.

Development of a Very Brief Measure of ADHD: The CHAOS Scale

OBJECTIVE

We sought to develop a brief, easy to use behavior checklist to address common limitations in the use of ADHD rating scales in busy clinical settings.

METHOD

Items for the CHAOS ( Conduct- Hyperactive- Attention Problem- Oppositional Symptom) scale were developed based on the ratings of Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria provided by experienced clinicians. The scale was administered to mothers of 205 clinically referred children for the purpose of subscale creation based on principal components analysis (PCA). Reliability and validity were analyzed using a separate sample of 139 children referred for psychological testing.

RESULTS

PCA resulted in four subscales (Attention Problems, Hyperactivity-Impulsivity, Oppositional Behavior, and Conduct Problems), which demonstrated moderate to high test-retest and interrater reliability. Subscale scores correlated significantly with subscales from a DSM-referenced behavior checklist, along with tests of executive functioning.

CONCLUSION

These data suggest that the CHAOS scale is a brief, psychometrically sound tool for evaluation and monitoring of ADHD symptoms.

Oppositional Defiant Disorder Is Better Conceptualized as a Disorder of Emotional Regulation

OBJECTIVE

It has been reported that Oppositional Defiant Disorder (ODD) can be differentiated into distinct subtypes associated with different outcomes in adulthood. We examined whether ODD is conceptually independent and coherent, and whether ODD and Conduct Disorder (CD) are expressions of the same core deficit.

METHOD

The data come from a sample of 4,380 children for whom SNAP rating scales were available. Parallel analysis was performed on the eight-item ODD diagnostic items and on the SNAP-90 scale. These were factor analyzed and the components were correlated.

RESULTS

ODD has one underlying factor, whereas the parent-rated SNAP has nine underlying factors. ODD items grouped together with emotional lability and irritability items, which did not group with CD. Confirmatory factor analysis supported the separation of ODD and CD but not ODD and emotion dysregulation.

CONCLUSION

The expanded ODD factor more likely captures a disorder of emotion regulation, rather than a disruptive behavior disorder.

Development process of an assessment tool for disruptive behavior problems in cross-cultural settings: the Disruptive Behavior International Scale - Nepal version (DBIS-N)

Systematic processes are needed to develop valid measurement instruments for disruptive behavior disorders (DBDs) in cross-cultural settings. We employed a four-step process in Nepal to identify and select items for a culturally valid assessment instrument: 1) We extracted items from validated scales and local free-list interviews. 2) Parents, teachers, and peers (n=30) rated the perceived relevance and importance of behavior problems. 3) Highly rated items were piloted with children (n=60) in Nepal. 4) We evaluated internal consistency of the final scale. We identified 49 symptoms from 11 scales, and 39 behavior problems from free-list interviews (n=72). After dropping items for low ratings of relevance and severity and for poor item-test correlation, low frequency, and/or poor acceptability in pilot testing, 16 items remained for the Disruptive Behavior International Scale-Nepali version (DBIS-N). The final scale had good internal consistency (α=0.86). A 4-step systematic approach to scale development including local participation yielded an internally consistent scale that included culturally relevant behavior problems.

The Contribution of Personality and Refugee Camp Experience to Callous and Unemotional Traits Among Immigrant Adolescents in the United States: Implications for the DSM-5 "Limited Prosocial Emotions" Specifier

Callous and Unemotional (C&U) traits characterize a group of adolescents who engage and persist in especially severe antisocial behaviors. These traits have been included in DSM-5 within a "Limited Prosocial Emotions" (LPE) specifier for Conduct Disorder. To investigate the generalizability of this specifier to non-Western cultures, we examined associations among Big Five personality, refugee camp experience, and C&U traits among 81 immigrant adolescents from non-Western cultures. Adolescents with refugee camp history endorsed higher levels of Uncaring than other adolescents. Personality traits explained 6 (Unemotional) to 18 % (Callousness) of the variance in C&U traits. The association between Neuroticism and Callousness held only for adolescents with a refugee camp history. Our results corroborate the importance of considering personality to understand C&U traits and the LPE specifier. Results also raise questions regarding the applicability of C&U traits to non-Western adolescents with varying pre-immigration experiences, and raise the possibility that the LPE specifier is vulnerable to false-positive identifications among such individuals.

Salivary oxytocin in adolescents with conduct problems and callous-unemotional traits

Callous-unemotional (CU) traits correlate with the severity and prognosis of conduct disorder in youth. The neuropeptide oxytocin (OT) has been linked to prosocial behaviors, including empathy and collaboration with others. This study discusses a possible role for OT in the biology of delinquent behavior. We hypothesized that in delinquent youth OT secretion will correlate with the severity of conduct problems and specifically with the level of CU traits. The study group included 67 male adolescents (mean age 16.2 years) undergoing residential treatment, previously assessed by an open clinical interview and history for the psychiatric diagnosis. Staff based Inventory of Callous-Unemotional traits for psychopathy and Strength and Difficulties Questionnaire were administered, and patients' medical and social personal files were systematically coded for previous history of antisocial acts using the Brown-Goodwin Questionnaire. Salivary OT was assayed by ELISA. Salivary OT levels were inversely correlated with conduct problems severity on Strength and Difficulties Questionnaire (r = -0.27; p ≤ 0.01). Recorded history of antisocial acts did not correlate with current OT levels. Odds ratio (OR) for significant CU traits among subjects with conduct problems was increased in low-OT (OR = 14, p ≤ 0.05) but not in high-OT subjects (OR = 6, p ≥ 0.05). Children with conduct problems and low levels of salivary OT are at risk for significant CU traits. These results suggest a possible role for salivary OT as a biomarker for CU traits and conduct problems severity.

Efficacy of an individualized social competence training for children with Oppositional Defiant Disorders/Conduct Disorders

OBJECTIVES

Group-based Cognitive-Behavioral Therapy of children with aggressive behavior has resulted in significant reductions of behavior problems with small to medium effect sizes. We report the efficacy of an individualized Treatment Program for Children with Aggressive Behavior.

METHOD

A within-subject design with two phases (waiting, treatment) was chosen. Sixty boys aged 6-12 years with peer-related aggressive behavior were included. The course of the outcome measures (growth rates) during a 6-week waiting phase was compared with those in the subsequent treatment phase (24 weekly child sessions together with an average of 8 parent contacts) by multilevel modeling. Primary outcome was peer-related aggressive behavior rated by parents. Further outcome measures included parent ratings and patient self-reports of aggressive and prosocial behavior.

RESULTS

During the treatment, growth rates for all parent-rated outcome measures were significant (p < .001) and comparison with the waiting phase indicated a stronger decrease in aggressive behavior and a stronger increase in prosocial behavior. For all self-rated outcome measures, growth rates during the treatment were significant (p < .01), but comparison with the waiting phase indicated a stronger decrease only for disturbance of social interaction.

CONCLUSIONS

The treatment program is an effective intervention for children with peer-related aggressive behavior.

Prevalence of Conduct Disorder in the Middle East: A Systematic Review and Meta-Analysis Protocol

BACKGROUND

The global burden of conduct disorder is a major public health concern. Although there are different reports on the prevalence of conduct disorder in different Middle Eastern countries, to date, no research has reviewed them. Therefore, we aimed to conduct a systematic review and meta-analysis on the literature and present the prevalence of conduct disorder among children and adolescents in Middle Eastern countries.

METHODS

Those cross-sectional studies with any type of random or non-random sampling, which described the prevalence of conduct disorder prior to age of 18, for at least one gender in the general or school-based populations who resided in Middle Eastern countries were included in this review. The scientific databases of PubMed, Scopus, Google Scholar, Index Medicus for the Eastern Mediterranean Region (IMEMR), Islamic World Science Citation Center (ISC), and Grey Literature including conference proceedings, and hand searching of key journals were searched from 1995 to the end of 2014. Two reviewers assessed the quality of the included studies independently and extracted the relevant data.

DISCUSSION

This review provided a picture of different frequencies of conduct disorder in Middle Eastern countries and analyzed the sources of heterogeneity.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42014014996.

The DSM-5 Limited Prosocial Emotions subtype of Conduct Disorder in incarcerated male and female juvenile delinquents

The aim of the present study was to analyze the relevance of the DSM-5's Conduct Disorder new Limited Prosocial Emotions (CD LPE) specifier in incarcerated juvenile delinquents. A sample of 201 males and 98 females from the Juvenile Detention Centers managed by the Portuguese Ministry of Justice diagnosed with Conduct Disorder (CD) was used. Results showed that male juvenile delinquents with the CD LPE specifier scored higher on callous-unemotional traits (CU), general psychopathic traits, psychopathy taxon membership, self-reported delinquency, and crime seriousness, and lower on prosocial behavior and social desirability, while female juvenile delinquents with the CD LPE specifier scored higher on callous-unemotional traits (CU) and general psychopathic traits, and lower on prosocial behavior. Significant associations for both genders were found between the CD LPE specifier and age of crime onset and first problems with the law.

Prosocial skills may be necessary for better peer functioning in children with symptoms of disruptive behavior disorders

Children with disruptive behavior disorders experience substantial social challenges; however, the factors that account for (i.e., mediate), or influence (i.e., moderate), peer problems are not well understood. This study tested whether symptoms of Oppositional Defiant Disorder and Conduct Disorder were associated with peer impairment and whether prosocial skills mediated or moderated these associations. Teacher ratings were gathered for 149 children (Mage = 9.09, SD = 1.71, 26% female) referred for behavioral concerns to an urban child psychiatry clinic. Path-analytic linear regressions testing mediation and moderation effects showed that prosocial skills significantly moderated the negative effects of symptoms of Conduct Disorder on peer impairment. Children showed less peer impairment only when they had relatively few conduct symptoms and high prosocial skills. Measurement of prosocial skills, in addition to conduct problems, may best capture factors which contribute to peer problems of children with disruptive behaviors.

Motor function and perception in children with neuropsychiatric and conduct problems: results from a population based twin study

Background

Children with early symptomatic psychiatric disorders such as Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) have been found to have high rates of motor and/or perception difficulties. However, there have been few large-scale studies reporting on the association between Conduct Disorder (CD) and motor/perception functions. The aim of the present study was to investigate how motor function and perception relate to measures of ADHD, ASD, and CD.

Methods

Parents of 16,994 Swedish twins (ages nine and twelve years) were interviewed using the Autism-Tics, ADHD and other Comorbidities inventory (A-TAC), which has been validated as a screening instrument for early onset child psychiatric disorders and symptoms. Associations between categorical variables of scoring above previously validated cut-off values for diagnosing ADHD, ASD, and CD on the one hand and motor and/or perception problems on the other hand were analysed using cross-tabulations, and the Fisher exact test. Associations between the continuous scores for ADHD, ASD, CD, and the subdomains Concentration/Attention, Impulsiveness/Activity, Flexibility, Social Interaction and Language, and the categorical factors age and gender, on the one hand, and the dependent dichotomic variables Motor control and Perception problems, on the other hand, were analysed using binary logistic regression in general estimated equation models.

Results

Male gender was associated with increased risk of Motor control and/or Perception problems. Children scoring above the cut-off for ADHD, ASD, and/or CD, but not those who were ‘CD positive’ but ‘ADHD/ASD negative’, had more Motor control and/or Perception problems, compared with children who were screen-negative for all three diagnoses. In the multivariable model, CD and Impulsiveness/Activity had no positive associations with Motor control and/or Perception problems.

Conclusions

CD symptoms or problems with Impulsiveness/Activity were associated with Motor control or Perception problems only in the presence of ASD symptoms and/or symptoms of inattention. Our results indicate that children with CD but without ASD or inattention do not show a deviant development of motor and perceptual functions. Therefore, all children with CD should be examined concerning motor control and perception. If problems are present, a suspicion of ADHD and/or ASD should be raised.

DTI-measured white matter abnormalities in adolescents with Conduct Disorder

Emerging research suggests that antisocial behavior in youth is linked to abnormal brain white matter microstructure, but the extent of such anatomical connectivity abnormalities remain largely untested because previous Conduct Disorder (CD) studies typically have selectively focused on specific frontotemporal tracts. This study aimed to replicate and extend previous frontotemporal diffusion tensor imaging (DTI) findings to determine whether noncomorbid CD adolescents have white matter microstructural abnormalities in major white matter tracts across the whole brain. Seventeen CD-diagnosed adolescents recruited from the community were compared to a group of 24 non-CD youth which did not differ in average age (12-18) or gender proportion. Tract-based spatial statistics (TBSS) fractional anisotropy (FA), axial diffusivity (AD), and radial diffusivity (RD) measurements were compared between groups using FSL nonparametric two-sample t test, clusterwise whole-brain corrected, p < .05. CD FA and AD deficits were widespread, but unrelated to gender, verbal ability, or CD age of onset. CD adolescents had significantly lower FA and AD values in frontal lobe and temporal lobe regions, including frontal lobe anterior/superior corona radiata, and inferior longitudinal and fronto-occipital fasciculi passing through the temporal lobe. The magnitude of several CD FA deficits was associated with number of CD symptoms. Because AD, but not RD, differed between study groups, abnormalities of axonal microstructure in CD rather than myelination are suggested. This study provides evidence that adolescent antisocial disorder is linked to abnormal white matter microstructure in more than just the uncinate fasciculus as identified in previous DTI studies, or frontotemporal brain structures as suggested by functional neuroimaging studies. Instead, neurobiological risk specific to antisociality in adolescence is linked to microstructural abnormality in numerous long-range white matter connections among many diverse different brain regions.

The efficacy of systemic therapy for childhood and adolescent externalizing disorders: a systematic review of 47 RCT

Systemic (family) therapy is a widely used psychotherapy approach. However, most systematic efficacy reviews have focused solely on "family-based treatment" rather than on the theoretic orientation "systemic therapy." We systematically review trials on the efficacy of systemic therapy for the treatment of childhood and adolescent externalizing disorders. All randomized (or matched) controlled trials (RCT) evaluating systemic/systems-oriented therapy in various forms (family, individual, group, multi-family group therapy) with child or adolescent index patients (0-17 years) suffering from mental disorders were identified by data base searches and cross-references. Inclusion criteria were as follows: index patient diagnosed with a DSM- or ICD-listed mental disorder, and trial published in any language up to the end of 2011. The RCTs were analyzed for their research methodology, interventions applied, and results (postintervention; follow-up). A total of 47 trials from the United States, Europe, and China, published in English, German, and Mandarin, were identified. A total of 42 of them showed systemic therapy to be efficacious for the treatment of attention deficit hyperactivity disorders, conduct disorders, and substance use disorders. Results were stable across follow-up periods of up to 14 years. There is a sound evidence base for the efficacy of systemic therapy for children and adolescents (and their families) diagnosed with externalizing disorders.

Understanding Youth Antisocial Behavior Using Neuroscience through a Developmental Psychopathology Lens: Review, Integration, and Directions for Research

Youth antisocial behavior (AB) is an important public health concern impacting perpetrators, victims, and society. Functional neuroimaging is becoming a more common and useful modality for understanding neural correlates of youth AB. Although there has been a recent increase in neuroimaging studies of youth AB and corresponding theoretical articles on the neurobiology of AB, there has been little work critically examining the strengths and weaknesses of individual studies and using this knowledge to inform the design of future studies. Additionally, research on neuroimaging and youth AB has not been integrated within the broader framework of developmental psychopathology. Thus, this paper provides an in-depth review of the youth AB functional neuroimaging literature with the following goals: 1. to evaluate how this literature has informed our understanding of youth AB, 2. to evaluate current neuroimaging studies of youth AB from a developmental psychopathology perspective with a focus on integrating research from neuroscience and developmental psychopathology, as well as placing this research in the context of other related areas (e.g., psychopathy, molecular genetics), and 3. to examine strengths and weaknesses of neuroimaging and behavioral studies of youth AB to suggest how future studies can develop a more informed and integrated understanding of youth AB.

Parental Depressive Symptoms and Adolescent Adjustment: Responses to Children's Distress and Representations of Attachment as Explanatory Mechanisms

OBJECTIVE

This study seeks to extend the investigation of parenting as an explanatory mechanism for relations between parental depressive symptoms and adolescent adjustment in the context of a four-wave longitudinal study.

DESIGN

Participants were cohabiting parents and their 320 children (156 boys, 164 girls). Parental depressive symptoms were assessed in kindergarten (T1), parental negative responses to children's emotional distress in first grade (T2), children's representations of attachment with parents in second grade (T3), and adolescent adjustment in seventh grade (T4).

RESULTS

Multiple pathways were identified in predicting adolescent conduct problems, including links involving (1) mothers' depressive symptoms, mothers' negative responses to children's distress and insecure father-child attachment representations; (2) fathers' depressive symptoms and insecure father-child attachment representations; and (3) fathers' depressive symptoms and negative responses to children's distress. A pathway was also found among mothers' depressive symptoms, mothers' negative responses to children's distress, insecure mother-child attachment representations, and peer problems in adolescence.

CONCLUSION

The findings support a role of parents' negative responses to children's distress and representations of father-child and mother-child attachment in relations between children's early experience with parental depressive symptoms and socioemotional outcomes in early adolescence.

Long Acting Risperidone in an Adolescent with Conduct Disorder: A Case Report

Adolescent conduct disorder (CD) is generally hard to manage clinically, as this population often refuses to take oral medications. Families and acquaintances of these adolescents usually suffer from extreme psychological, financial and social difficulties. Oral antipsychotics are the primary drugs of choice clinically, after behavioral treatments. Here we report a case with attention deficit hyperactivity disorder and conduct disorder who refuses to take any medications, was not eligible for behavioral treatments and was treated successfully with long acting risperidone.

Hyperkinetic Syndrome: The role of allergy among psychological and neurological factors

The role of allergies was examined in a clinical sample of 122 successive referrals with suspected Hyperkinetic Syndrome (HKS). The children were examined using general psychiatric, neurological and immunologic measures. According to these examinations, 18 of the 122 children (15%) did not meet the criteria for a diagnosis of HKS. These children served as a small comparison group since healthy children could not be examined for ethical reasons. A history of allergies was more often positive in children with HKS without associated disorders (50%) and in children with HKS and developmental retardations (36%) than in children with HKS and conduct disorders (23%) and the comparsion group (17%). The objective immunologic measures which essentially covered IgE-mediated reactions were not significantly different. These results are discussed on the background of delayed non-IgE-mediated reactions and possible psychosocial influences. There were no significant correlations between the neurological and psychiatric measures on the one hand and immunologic measures on the other. Factor analysis on the basis of the applied measures revealed three main dimensions but none of these could be interpreted as distinctive "immunologic" dimension.