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PubMed2006

A comparison of girls' and boys' aggressive-disruptive behavior trajectories across elementary school: prediction to young adult antisocial outcomes.

Multiple group analysis and general growth mixture modeling was used to determine whether aggressive- disruptive behavior trajectories during elementary school, and their association with young adulthood antisocial outcomes, vary by gender. Participants were assessed longitudinally beginning at age 6 as part of an evaluation of 2 school-based preventive programs. Two analogous trajectories were found for girls and boys: chronic high aggression- disruption (CHAD) and stable low aggression- disruption (LAD). A 3rd class of low moderate aggression- disruption (LMAD) for girls and increasing aggression- disruption (IAD) for boys also was found. Girls and boys in analogous CHAD classes did not differ in trajectory level and course, but girls in the CHAD and LAD classes had lower rates of antisocial outcomes than boys. Girls with the LMAD trajectory differed from boys with the IAD trajectory.

Achievement↗

PubMed2005

The therapeutic alliance in cognitive-behavioral treatment of children referred for oppositional, aggressive, and antisocial behavior.

The authors examined the therapeutic alliance in evidence-based treatment for children (N = 185, 47 girls, 138 boys; ages 3-14 years) referred clinically for oppositional, aggressive, and antisocial behavior. Different alliances (child-therapist, parent-therapist) were assessed from each participant's perspective at 2 points over the course of treatment. As predicted, both child-therapist and parent-therapist alliances related to therapeutic change, family experience of barriers to participation in treatment, and treatment acceptability. Greater alliance was associated with greater therapeutic change, fewer perceived barriers, and greater treatment acceptability. The findings could not be attributed to the influence of socioeconomic disadvantage, parent psychopathology and stress, and child dysfunction or to rater effects (common rater variance in the predictors and criteria).

Adolescent↗

PubMed2003

Preventive intervention for urban, low-income preschoolers at familial risk for conduct problems: a randomized pilot study.

Conducted a pilot study to test the feasibility of a prevention program for promoting parenting in families of preschoolers at high risk for behavior problems. Risk status was based on a family history of antisocial behavior and residence in a low-income, urban community. Thirty preschoolers (ages 21/2 to 5) and their parents were randomly assigned to a 1-year, home- and clinic-based intervention or to a no-intervention control condition. Despite families' multiple risk factors, high rates of attendance and satisfaction were achieved. Relative to controls, intervention parents were observed to be significantly more responsive and use more positive parenting practices. Results support the feasibility of engaging high-risk families in an intensive prevention program. The meaningful changes achieved in parenting suggest that a preventive approach is promising for families with multiple risk factors.

Adult↗

PubMed2006

Child-therapist and parent-therapist alliance and therapeutic change in the treatment of children referred for oppositional, aggressive, and antisocial behavior.

BACKGROUND: We examined the therapeutic alliance in evidence-based treatment for children (N = 77, 19 girls, 58 boys, ages 6-14) referred clinically for oppositional, aggressive, and antisocial behavior. METHOD: Different alliances (child-therapist, parent-therapist) were assessed from each participant's perspective at two points over the course of treatment. Both the quality of the child-therapist and the parent-therapist alliance predicted therapeutic changes in the children; the parent-therapist alliance also predicted improvements in parenting practices in the home. RESULTS: The findings could not easily be attributed to the influence of other domains (socioeconomic disadvantage, parent psychopathology and stress, and severity of child dysfunction) known to predict therapeutic change or to rater effects (common rater variance) in the predictors and criteria. CONCLUSION: The therapeutic alliance warrants increased attention to understand the precise role in treatment and whether or how the alliance can be mobilized to enhance change.

Adolescent↗

PubMed2006

MAOA, maltreatment, and gene-environment interaction predicting children's mental health: new evidence and a meta-analysis.

Previous research on adults has shown that a functional polymorphism in the promoter region of the monoamine oxidase A (MAOA) gene moderates the impact of childhood maltreatment on risk for developing antisocial behavior. Thus far, attempts to replicate this finding have been mixed. The current study (i) presents new data investigating this finding in a sample of 975 seven-year-old boys, and (ii) evaluates the extant data by conducting a meta-analysis of published findings. We replicated the original finding by showing that the MAOA polymorphism moderates the development of psychopathology after exposure to physical abuse, we extended the finding to childhood closer in time to the maltreatment experience, and we ruled-out the possibility of a spurious finding by accounting for passive and evocative gene-environment correlation. Moreover, meta-analysis demonstrated that across studies, the association between maltreatment and mental health problems is significantly stronger in the group of males with the genotype conferring low vs high MAOA activity. These findings provide the strongest evidence to date suggesting that the MAOA gene influences vulnerability to environmental stress, and that this biological process can be initiated early in life.

Adolescent↗

PubMedDate not supplied

[Evaluation of typical psychopathic traits with juvenile offenders].

UNLABELLED: The concept of psychopathy has received many definitions for the first days of psychiatry. Recently, the Hare's Psychopathy Check List Revised has been created. This scale has the advantage to investigate the classically characteristic traits of the syndrome (need of stimulation, lack of culpability, superficial activity, lack of empathy, impassivity) and to point out the early development of behavior disturbances. In the American classification (DSM IV), oppositional and aggressive behavior in child and adolescent is grouped under the Conduct Disorder diagnostic criteria. This trouble appears to be a strong predictive factor of psychopathy in adult. Identifying the high risk factors of evolution to psychopathic personality would allow an earlier intervention and prevention by multisystemic interventions for example. The present study aims to evaluate in what measure characteristic traits of psychopathy in adults are present in severe juvenile offenders and to point out, in a second time, the differences between adolescents meeting the DSM IV criteria for Conduct Disorder and a control population by a dimensional personality inventory. METHOD: The sample consists in 47 severe juvenile offenders referred for at least 3 months by a Youth Court to a Public Institution for Youth Protection (Belgium, Wauthier-Braine, 1999-2001), who have given an oral contentment and completely fulfilled the Temperament and Character Inventory-TCI. We have collected data about: schooling year by year, number of fails, changes of school; antecedents of oppositional defiant disorder with provocation (ODD, DSM IV criteria); antecedent of Conduct Disorder (CD, DSM IV criteria); penal antecedents (Youth Judge, works of general interest, placements); medico-psychological antecedents (consultation to a psychologist or a psychiatrist, hospitalization, illness, surgical intervention); psychoactive drug use or abuse. We used the TCI--Temperament and Character Inventory. This is a dimensional personality inventory. Based on biological, genetic and clinical hypothesis, it describes 2 types of variables defining personality: Variables of temperament (genetically transmitted and biologically controlled), and Variables of character (learned part of the personality reflecting the degree of adaptation and maturity, varying with environment through development). We have chosen this tool because of its dimensional aspect. Adolescence being a time of psychological and personality changes, such a tool is more useful than a categorical one. We also used this tool to verify the existence of the specific triad described by Cloninger and Svrakic. According to these authors, psychopathic personality in adult is characterized by a specific triad in which novelty seeking is high while harm avoidance and reward dependence are low. These observations are highly correlated to Hare's definition of psychopathy. We give the principal scores for the 7 personality dimensions expressed in global scores (total of the items for each dimension) and pondered ones (global scores divided by the number of items of the dimension x 100). RESULTS: Statistical analysis was performed with the Stateview 5.0 t-test program for data analysis. Statistical results show the absence of a statistically significant difference between the 2 groups for TCI 1, 4.5 and 7 but a statistically significant difference for TCI 2, 3 and 6 (p <.0001). DISCUSSION: The first limitation of our study is linked to the sample composed of young adolescents placed in an Institution for Youth Protection who doesn't reflect the whole population of offenders. A second limitation is correlated to the randomization system: randomization for age but not for sex, ethnical and cultural origin and socioeconomic status. Our results with adolescent offenders don't completely meet the Cloninger's psychopathy triad in adults. Moreover, in literature data, aggressive behavior is correlated to high novelty seeking and associated with low harm avoidance, reward dependence and persistence in children, these items are predictive of antisocial behavior in teenage and young adulthood. In our sample where antisocial behaviors are severe, we should be expecting a high novelty seeking but that is not the case. Our results should be explained by the fact that adolescence in itself is a more powerful factor of high novelty seeking than psychopathic trait. Harm avoidance and reward dependence seem to be a real problem in offending population and reflect aggressive behaviors in adolescents (lack of harm perception, sensitivity and empathy). Another interesting element is the cooperation factor that is significantly lower in the study group. This seems to comfort the hypothesis of a lower social maturity in institutionalized adolescents. CONCLUSION: Regarding to a control group subjects from 15 to 25 years old, adolescent offenders observed in an Institution for Youth Protection show a significantly different profile in the TCI for Harm Avoidance, Reward Dependence and Cooperation. Regarding to adult psychopaths, adolescent offenders partially meet the classical diagnostic triad of psychopathy, what should be indicating that such adolescents already show emotional perturbations: lower harm avoidance, reward dependence and cooperation than control population. This third factor is not characteristic of psychopathy but reflects relational difficulties, which are important in adolescent offenders. So, our study point out the complex psychopathology of adolescent offenders and the coexistence in such adolescents of attachment disorder and the difficulty to treat them because of their multiple lacks (cognitive, psychopathological, familial and scholar). We think important to discuss the necessity of approaches based on the development of personal creative abilities and involving all the professionals concerned in the young's universe. Future researches should compare adolescent offenders and controls randomized for age, sex, socioeconomic, ethnical and cultural status. They also should test specifically the diagnostic triad of psychopathology developed by Cloninger, especially the novelty seeking dimension. Moreover, it would be interesting to integrate these results in a wider protocol and to compare them with clinical, forensic and neurocognitive data, individually and within the familial context.

Adolescent↗

PubMed2001

Childhood depression and adult personality disorder: alternative pathways of continuity.

BACKGROUND: This study extends previous findings of the risks posed by childhood major depressive disorder and other psychopathological features for later personality disorder (PD) in a random sample of 551 youths. METHODS: Self-reports and mother reports were used to evaluate DSM-III-R (Axes I and II) psychiatric disorders at mean ages of 12.7, 15.2, and 21.1 years. Logistic regression was used to examine the independent effects of major depressive disorder in childhood or adolescence on 10 PDs in young adulthood. RESULTS: Odds of dependent, antisocial, passive-aggressive, and histrionic PDs increased by more than 13, 10, 7, and 3 times, respectively, given prior major depressive disorder. Those effects were independent of age, sex, disadvantaged socioeconomic status, a history of child maltreatment, nonintact family status, parental conflict, preexisting PD in adolescence, and other childhood or adolescent Axis I psychopathological features, including disruptive and anxiety disorders. In addition, odds of schizoid and narcissistic PD increased by almost 6 times and odds of antisocial PD increased by almost 5 times given a prior disruptive disorder, and odds of paranoid PD increased by 4 times given a prior anxiety disorder. CONCLUSION: Personality disorders may represent alternative pathways of continuity for major depressive disorder and other Axis I disorders across the child-adult transition.

Adolescent↗

PubMed2002

Psychiatric disorders in youth in juvenile detention.

BACKGROUND: Given the growth of juvenile detainee populations, epidemiologic data on their psychiatric disorders are increasingly important. Yet, there are few empirical studies. Until we have better epidemiologic data, we cannot know how best to use the system's scarce mental health resources. METHODS: Using the Diagnostic Interview Schedule for Children version 2.3, interviewers assessed a randomly selected, stratified sample of 1829 African American, non-Hispanic white, and Hispanic youth (1172 males, 657 females, ages 10-18 years) who were arrested and detained in Cook County, Illinois (which includes Chicago and surrounding suburbs). We present 6-month prevalence estimates by demographic subgroups (sex, race/ethnicity, and age) for the following disorders: affective disorders (major depressive episode, dysthymia, manic episode), anxiety (panic, separation anxiety, overanxious, generalized anxiety, and obsessive-compulsive disorders), psychosis, attention-deficit/hyperactivity disorder, disruptive behavior disorders (oppositional defiant disorder, conduct disorder), and substance use disorders (alcohol and other drugs). RESULTS: Nearly two thirds of males and nearly three quarters of females met diagnostic criteria for one or more psychiatric disorders. Excluding conduct disorder (common among detained youth), nearly 60% of males and more than two thirds of females met diagnostic criteria and had diagnosis-specific impairment for one or more psychiatric disorders. Half of males and almost half of females had a substance use disorder, and more than 40% of males and females met criteria for disruptive behavior disorders. Affective disorders were also prevalent, especially among females; more than 20% of females met criteria for a major depressive episode. Rates of many disorders were higher among females, non-Hispanic whites, and older adolescents. CONCLUSIONS: These results suggest substantial psychiatric morbidity among juvenile detainees. Youth with psychiatric disorders pose a challenge for the juvenile justice system and, after their release, for the larger mental health system.

Adolescent↗

PubMed2003

Prior juvenile diagnoses in adults with mental disorder: developmental follow-back of a prospective-longitudinal cohort.

BACKGROUND: If most adults with mental disorders are found to have a juvenile psychiatric history, this would shift etiologic research and prevention policy to focus more on childhood mental disorders. METHOD: Our prospective longitudinal study followed up a representative birth cohort (N = 1037). We made psychiatric diagnoses according to DSM criteria at 11, 13, 15, 18, 21, and 26 years of age. Adult disorders were defined in the following 3 ways: (1) cases diagnosed using a standardized diagnostic interview, (2) the subset using treatment, and (3) the subset receiving intensive mental health services. Follow-back analyses ascertained the proportion of adult cases who had juvenile diagnoses and the types of juvenile diagnoses they had. RESULTS: Among adult cases defined via the Diagnostic Interview Schedule, 73.9% had received a diagnosis before 18 years of age and 50.0% before 15 years of age. Among treatment-using cases, 76.5% received a diagnosis before 18 years of age and 57.5% before 15 years of age. Among cases receiving intensive mental health services, 77.9% received a diagnosis before 18 years of age and 60.3% before 15 years of age. Adult disorders were generally preceded by their juvenile counterparts (eg, adult anxiety was preceded by juvenile anxiety), but also by different disorders. Specifically, adult anxiety and schizophreniform disorders were preceded by a broad array of juvenile disorders. For all adult disorders, 25% to 60% of cases had a history of conduct and/or oppositional defiant disorder. CONCLUSIONS: Most adult disorders should be reframed as extensions of juvenile disorders. In particular, juvenile conduct disorder is a priority prevention target for reducing psychiatric disorder in the adult population.

Adolescent↗

PubMed2000

Antisociality, substance dependence, and the DRD5 gene: a preliminary study.

A pilot population-based study of a microsatellite polymorphism at the DRD5 locus in adult European-Americans showed its association with childhood symptom counts for oppositional defiant disorder (ODD) in males and females and adult antisocial personality disorder (ASPD) in females. No association with childhood conduct disorder symptom count was observed. ODD mediated the genotype-ASPD relationship in females. Neither ODD nor ASPD significantly mediated the relationship between the genotype and the liability to substance dependence (SD). The data suggest involvement of the DRD5 locus in the variation and sexual dimorphism of SD liability and antisociality and in the developmental continuity of antisociality.

Antisocial Personality Disorder↗

PubMed2002

Characteristics of girls with early onset disruptive and antisocial behaviour.

BACKGROUND: Crime, particularly among juvenile females, has increased in recent years. Little is known, however, about the development and precursors in childhood of female delinquent behaviour. This is primarily due to a lack of consensus on how to define and assess female antisocial behaviour, and a lack of studies using sufficiently large samples. METHOD: A community sample of 2451 girls between the ages of five and eight years were recruited into a longitudinal study following the enumeration of 103,238 households in the city of Pittsburgh. Data on disruptive and antisocial behaviours were collected from parents, teachers and children during the first wave of the study. RESULTS: Prevalence rates of disruptive disorders varied by choice of informants and measurement thresholds. The prevalence of most disruptive behaviours was similar across the four age cohorts. Where there were differences, parents of younger girls tended to report fewer problematic behaviours compared with parents of older girls. Teachers reported more disruptive behaviours than parents and, by their reports, older girls were more likely to show oppositional/defiant behaviour and relational aggression than younger girls. Girls scoring highly on several domains relative to their peers were over-represented in disadvantaged neighbourhoods. CONCLUSIONS: A range of disruptive disorders are present among a subgroup of females at an early age, particularly among girls in the most disadvantaged neighbourhoods. Longitudinal follow-up is required to examine the developmental trajectories and predictive utility of these behaviours. The implications for clinical interventions are discussed.

Adolescent↗

PubMed2006

Adolescent outcome of disruptive behaviour disorder in children who had been treated in in-patient and day-treatment settings.

Although several studies have been conducted on the longitudinal course of childhood disruptive behaviours in community samples and in general psychiatric samples, little is known about adolescent adjustment in psychiatrically treated disruptive behaviour disorder (DBD) children. We examined a sample of adolescents (n = 47) who had been treated as children in an in-patient and/or day-treatment setting because of their severely disruptive behaviour. At follow-up, we found that half of the adolescents had a DBD diagnosis, and on average higher numbers of participants ever used soft drugs, had ever been in court, were not attending school when this was mandatory, and were smoking on a daily basis, as compared to comparison groups. There was, however, a large variance among the adolescents of our sample. When outcome was defined in terms of DBD diagnosis, living status, delinquency, school attendance, and smoking behaviour, 38 % had a positive outcome and 34 % had a poor outcome. For clinical purposes, it is important to recognise that there are large individual differences in outcome.

Adolescent↗

PubMed2006

Does maternal psychopathology discriminate between children with DSM-IV generalised anxiety disorder or oppositional defiant disorder? The predictive validity of maternal axis I and axis II psychopathology.

What dimensions of maternal psychopathology predict internalising or externalising disorder in children? We conducted a study of maternal axis I and axis II psychopathology in a group of children 8-12 years of age with Generalised Anxiety Disorder (GAD), Oppositional Defiant Disorder (ODD) and non-patient controls (NC). By using Multigroup Discriminant Analyses (MDA) on three groups of children (N = 85) and measures of axis I and axis II psychopathology of their mothers, we attempted to discriminate between these groups on a data driven basis. Two separate MDA were computed, one based on maternal axis I disorders, and one based on maternal axis II disorders. The results demonstrated that maternal symptomatic and personality psychopathology was differentially related to childhood anxiety or behavioural disorders. Mothers of children with ODD were characterised by more negative emotions and detached personality styles, whereas mothers of children with GAD seemed to be more somatic preoccupied, controlling and over-protective.

Anxiety Disorders↗

PubMed2001

Evaluating empirically based psychotherapy research for children and adolescents.

Psychotherapy research improved its methodological rigor in the last half of the past century and as we begin a new millennium and a new generation of research it is important to evaluate its effectiveness. In this article the historical perspective of psychotherapy evaluation is reviewed, followed by the presentation of the Child Task Force criteria for evaluating psychotherapy outcomes. The results of the American Psychological Association Task Force review of well-established and probably efficacious treatments for depression, anxiety, disruptive behavior disorders and attention deficit hyperactivity for child and adolescent disorder are presented. Finally, the advantages and disadvantages of these very structured criteria for evaluating psychotherapy research with children and adolescents are discussed, and future directions are proposed.

Adolescent↗

PubMed2004

Empirically tested psychotherapies for youth internalizing and externalizing problems and disorders.

This article is a review of specific psychotherapies that have been supported in clinical trials. Treatments that showed significant effects in studies published over a period of 4 decades were identified, with the goal of complementing the overall picture of treatment benefit provided in narrative reviews and meta-analyses with a detailing of the specific interventions that have shown significant effects. The article focuses on treatments for four broad clusters of problems and disorders that account for a very large proportion of youth mental health referrals: anxiety, depression, attention-deficit/hyperactivity, and conduct.

Adolescent↗

PubMed2006

Rates of DSM-IV psychiatric disorders among adolescents in a large metropolitan area.

We present prevalence data for adolescents in a large metropolitan area in the US and the association of DSM-IV diagnoses to functional impairment and selected demographic correlates. We sampled 4175 youths aged 11-17 years from households enrolled in large health maintenance organizations. Data were collected using questionnaires and the Diagnostic Interview Schedule for Children, Version IV (DISC-IV). Impairment was measured using the Child Global Assessment Scale and diagnostic specific impairment in the DISC-IV. 17.1% of the sample met DSM-IV criteria for one or more disorders in the past year; 11% when only DISC impairment was considered and 5.3% only using the CGAS. The most prevalent disorders were anxiety (6.9%), disruptive (6.5%), and substance use (5.3%) disorders. The most prevalent specific disorders were agoraphobia, conduct and marijuana abuse/dependence, then alcohol use and oppositional defiant disorder. Younger youths and females had lower odds for any disorder, as did youths from two parent homes. There was increased odds associated with lower family income. Females had greater odds of mood and anxiety disorders, males of disruptive and substance use disorders. There were greater odds of mood and disruptive disorders for older youths. Prevalences were highly comparable to recent studies using similar methods in diverse non-metropolitan populations. We found associations with age, gender, and to a lesser extent, socioeconomic status reported in previous studies. The inclusion of both diagnosis-specific impairment and global impairment reduced prevalence rates significantly. Our results suggest commonality of prevalences and associated factors in diverse study settings, including urban and rural areas.

Adolescent↗

PubMed2005

History of attention-deficit hyperactivity disorder symptoms and opioid dependence: a controlled study.

The co-occurrence of attention-deficit hyperactivity disorder (ADHD) and substance use disorders has received considerable attention in recent clinical and scientific investigations. These two disorders are linked to one another in a variety of ways. The core symptoms of ADHD may be mimicked by the effects of psychoactive substance use, making it difficult to diagnose one disorder in the presence of the other. Individuals with ADHD may demonstrate earlier onset of the substance abuse and a pattern of more frequent or intense use. ADHD symptoms were explored as possible antecedents of opioid dependence. A total of 109 adult opioid-dependent, treatment-seeking male and female outpatients were investigated with an extended clinical semistructured interview to collect sociodemographic, drug-related, and clinical data. The results indicate that ADHD alone does not predispose the development of opioid dependence in our sample. Childhood ADHD symptoms may nevertheless be found more frequently related to school performance problems and difficulties in social adaptation, which was identified in more than half of our population. Patients with ADHD history seemed to experience a drug abuse career with more complications which need to be recognized with focused attention in order to start earlier treatment strategies.

Adolescent↗

PubMed2001

Parent-child interactions and anxiety disorders: an observational study.

Past research has indicated a potential link between anxiety and parenting styles that are characterised by control and rejection. However, few studies have utilised observational methods to support these findings. In the current study, mother-child interactions were observed while the child completed two difficult cognitive tasks. The sample consisted of clinically anxious children (n=43), oppositional defiant children (n=20) and non-clinical children (n=32). After adjusting for the age and sex of the child, mothers of anxious children and mothers of oppositional children displayed greater and more intrusive involvement than mothers of non-clinical children. Mothers of anxious children were also more negative during the interactions than mothers of non-clinical children. The differences between anxious and non-clinical interactions were equivalent across three separate age groups. The results support the relationship between an overinvolved parenting style and anxiety but question the specificity of this relationship.

Adolescent↗