Taxonomy and comorbidity of conduct problems: Evidence from empirically based approaches

Dimensional foundations toward a novel nosology addressing comorbidity: Preadolescent syndrome profiles

OBJECTIVE

Traditional categorical systems for diagnosing psychopathological symptoms, such as the DSM-5, face limitations including high comorbidity rates and insufficient support for transdiagnostic treatment protocols. Dimensional, person-centered approaches can address these limitations by focusing on cross-cutting psychiatric symptoms.

METHOD

This study leverages data from the Adolescent Brain Cognitive Development℠ Study (ABCD Study®) to develop dimensional models of preadolescent psychopathology, focusing on a large, diverse sample of youths aged 9-10. We used latent profile analysis (LPA) on Child Behavior Checklist (CBCL) syndrome scales collected from an elevated symptomatology subsample to delineate subgroups for targeted interventions.

RESULTS

Four distinct profiles emerged: "Mildly Elevated" and "Highly Elevated" (on both internalizing and externalizing), "Moderately Elevated - Rule-Breaking," and "Moderately Elevated - Internalizing & Thought Problems." These profiles differed significantly across sociodemographic, neurocognitive, and life experience characteristics. The "Highly Elevated" group showed the highest levels of risk, including greater trauma exposure and higher rates of parental psychopathology. In contrast, the "Mildly Elevated" group demonstrated lower levels of risk factors and higher fluid intelligence compared to the other groups. The two Moderately Elevated profiles were largely similar across most risk indicators, though the Internalizing & Thought Problems group had a slightly higher proportion of parents with a college education.

CONCLUSIONS

These profiles offer the beginnings of a foundation for classifying symptom co-occurrence and highlight the need for developmentally specific nosologies to improve risk detection and intervention strategies. Future research should further validate these profiles and explore their stability across developmental stages to inform targeted interventions.

Longitudinal associations between deviant peer affiliation and externalizing behavior in Chinese preadolescence: Differentiating between-person effects from within-person effects

The present study employed the cross-lagged panel model and the random intercepts cross-lagged panel model to investigate the longitudinal association between deviant peer affiliation and externalizing behavior in Chinese preadolescents. A sample of 1987 students, comprising 56.10% male participants with a mean age of 12.32 years (SD = 0.53), from Guangdong and Shandong provinces, completed the Deviant Peer Affiliation Scale and the Externalizing Behavior Scale in biannual surveys. The surveys were conducted in the autumn semester of 7th grade, the spring semester of 7th grade, and the autumn semester of 8th grade. The cross-lagged panel model illustrated a bidirectional association between adolescents' involvement with deviant peers and externalizing behavior. Conversely, the random intercepts cross-lagged panel model indicated a positive association between deviant peer affiliation and externalizing behavior at the between-person level. At the within-person level, a significant predictive correlation was identified between the association with deviant peers and subsequent externalizing behavior, whereas the reverse pathway was determined to be statistically insignificant. To comprehend the connection between deviant peer association and externalizing behavior in preadolescence, it is essential to differentiate between between-person and within-person effects and utilize a sophisticated research methodology.

Parent and child personality characteristics as predictors of negative discipline and externalizing problem behaviour in children

Negative discipline has been linked to childhood externalizing behaviour. However, relatively little attention has been given to the potential effect of individual personality characteristics of children and parents. Using the Five Factor Model, we examined the extent to which parents' and children's personality characteristics were related to parenting and children's externalizing behaviour in a proportional stratified general population sample (N=599) of elementary‐school‐aged children. Based on Patterson's macromodel of parenting, an initial model was built, hypothesizing that the impact of parents' and child's personality dimensions on externalizing problems was fully mediated by negative discipline. Results supported a modified model that added direct pathways between parent and child personality characteristics and externalizing problem behaviour. For the mother data, as well as for the father data, children's Extraversion and Imagination were positively related to children's externalizing problem behaviours. Children's Benevolence and Conscientiousness and parents' Emotional Stability were negatively related to externalizing problem behaviours. For the mother data, maternal Agreeableness was positively related to externalizing problem behaviours too. Copyright © 2003 John Wiley & Sons, Ltd.

Is the Revised Psychopathy Checklist Clinically Useful for Adolescents?

Recent studies have provided evidence for the reliability and validity of Hare's Psychopathy Checklist, Revised (PCL-R) for forensic samples. The present study investigated PCL-R psychometric properties among Caucasian and African-American adolescent males from forensic and school settings. The clinical utility of the PCL-R was investigated in terms of predicting future delinquency above and beyond data that are more readily available. Good reliability and validity for the PCL-R were found. PCL-R Total and Factors scores were greatest for participants with conduct disorder, followed by those with oppositional defiant disorder, with the smallest scores observed for participants with neither disorder. In a 1-year follow-up, PCL-R scores accounted for a unique proportion of the variance in juvenile criminal justice sentencing above and beyond the baseline number of delinquent acts recorded in juvenile criminal justice records and above a baseline disruptive behavior diagnosis continuum score. Compared to conduct disorder diagnosis, the PCL-R psychopath threshold score provided much better sensitivity with only slightly worse specificity for predicting delinquency during the 1-year follow-up.

Fledgling Psychopathy in the Classroom: ADHD Subtypes Psychopathy, and Reading Comprehension in a Community Sample of Adolescents

The current study explores characteristics that are associated with fledgling psychopathy and educational outcomes relating to reading comprehension performance in a community sample of 432 middle school students. Latent class analysis (LCA) produced a four-class solution. Class 1 was a large (71.5% of sample) ''control'' group of youths with no attention/hyperactivity deficits and the highest reading comprehension scores. Class 2 was 11.6% of the sample and was consistent with traits associated with attention deficit hyperactivity disorder (ADHD) predominantly inattentive type. Class 3 was 7.4% of the sample and was consistent with traits associated with ADHD predominantly hyperactive-impulsive type. Class 4 was 9.5% of the sample and was consistent with traits associated with ADHD combined type. Classes 2 and 4 were characterized by elevated levels of psychopathic and callous-unemotional (CU) traits and lower educational performance. This study extends the utility of fledgling psychopathy to educational outcomes, which has broad implications for adolescent development, delinquency, and youth violence.

Longitudinal patterns of physical aggression: Associations with adult social, psychiatric, and personality functioning and testosterone levels

A retrospective longitudinal research design was used to evaluate male adult outcomes associated with four patterns of physical aggression from childhood to adulthood—child-only aggression, child and adult continuity of aggression, adult-onset aggression, and a contrast group with low levels of aggression in childhood and adulthood. The continuity and adult-onset aggression groups had the highest levels of social maladjustment (e.g., marital instability), psychiatric disturbance (e.g., alcohol disorders, major depression), personality dysfunction (e.g., higher prevalence of elevated borderline and narcissistic personality disorder scores), and higher plasma testosterone levels. The child-only aggression group manifested more psychiatric and personality disturbance than the contrast group, but not nearly as much disturbance as the continuity and adult-onset groups. After controlling for age and socioeconomic status (SES) variables, race (White/Black) was typically not a significant predictor of outcome variables. Findings are discussed with regard to life course implications of the physical aggression patterns, and of the support provided for an adult-onset aggressive type.

Behavior problems in 5-year-old monozygotic and dizygotic twins: Genetic and environmental influences, patterns of regulation, and internalization of control

Genetic influence on externalizing problems, internalizing problems, and attentional/activity problems in 5-year-olds was consistently identified across informants and assessment contexts. Effects of the shared environment were identified as well but with less consistency (i.e., only from parents, not teachers, and more from father than mother reports). Correlations between observed patterns of regulation at ages 3, 4, and 5 years and behavior problems at age 5 years were often significant, but low in magnitude and specific to teacher reports. Adaptive internalization of control at each age (e.g., frustration tolerance, capacity to attend and focus, good impulse control) predicted fewer externalizing problems. Internalization of standards, reflected in children's moral themes, understanding of reciprocity, and constructive social problem solving, also were sometimes associated with fewer problems. Significant correlations were low in magnitude and again specific to teacher reports. Externalizing problems were more prevalent for boys than girls, and regulation (i.e., internalization of control and standards) was more characteristic of girls than boys.

Childhood-onset versus adolescent-onset antisocial conduct problems in males: Natural history from ages 3 to 18 years

We report data that support the distinction between childhood-onset and adolescent-onset type conduct problems. Natural histories are described from a representative birth cohort of 457 males studied longitudinally from age 3 to 18 years. Childhood- and adolescent-onset cases differed on temperament as early as age 3 years, but almost half of childhood-onset cases did not become seriously delinquent. Type comparisons were consistent with our contention that males whose antisocial behavior follows a life-course-persistent path differ from males who follow an adolescence-limited path. As adolescents, the two types differed on convictions for violent crime, personality profiles, school leaving, and bonds to family. These differences can be attributed to developmental history because the two groups were well matched on measures of antisocial conduct at age 18 years: parent-reports, self-reports, and adjudication records. By age 18 years, many conduct-problem boys had encountered factors that could ensnare them in an antisocial future: substance dependence, unsafe sex, dangerous driving habits, delinquent friends, delinquent perceptions, and unemployment. Implications for theory, research design, prevention, and therapeutic treatment of conduct problems are highlighted.

Teacher reports of peer aggression in preschool: its relationship to DSM-IV externalizing symptoms

OBJECTIVE

to establish the prevalence and associations of peer aggression as manifested in preschool children, in community-based populations and to study links with DSM-IV externalizing diagnoses.

METHOD

Subjects were 1104 children, 3-to-5-year-olds attending rural and urban pre-schools classes. Teachers completed the Peer Conflict Scale (PCS) to inform about direct physical and verbal aggression, object aggression and symbolic aggression and the questionnaire on psychopathology ECI-4.

RESULTS

6.6% (n=73) had at least one positive item on the PCS. This percentage dropped to 2.6% (n=29) if we take into account a minimum of three positive items. Physical direct aggression was the more prevalent type of aggressive behavior, followed by verbal aggression, object aggression and symbolic aggression. Significant differences by gender and age were found. Peer aggression was associated with male gender from three years of age. Physical, object and verbal aggressive behavior was linked with externalizing disorders. This association was very strong with oppositional disorder.

CONCLUSIONS

The present research with a Spanish population confirms the existence of peer aggression in preschoolers and the gender differences. Our chief contribution is about the age of emergence of sex differences and gender differences in different types of peer aggression.

Developmental considerations in the investigation of conduct disorder

The papers in this special issue attest to the theoretical and empirical advances that have been made in understanding the epidemiology, subtypes, etiology, neuropsychology, psychobiology, course, consequences, prevention, and treatment of conduct disorder (CD) (see also Kazdin, 1987; Loeber, 1990; Loeber & Stouthamer-Loeber, 1986; Moffitt, 1990; Patterson, 1982; Robins, 1991; White, Moffitt, Earls, Robins, & Silva, 1990). A number of theoretical conceptualizations have been forwarded in an attempt to comprehend this complex form of disorder in children. Such divergence in thinking indicates that the topic of CD has evolved into an active and significant domain of inquiry. To date, however, there has been no unifying theoretical framework for bringing conceptual clarity to the diverse perspectives represented in the study of conduct disorder. Although existing work within particular disciplines and subdisciplines has provided substantial contributions to our understanding of CD, these accounts typically have not considered the broader matrix of complex and evolving biological, cognitive, socioemotional, representational, and social-cognitive capacities of the developing child. As a consequence, disparate theoretical formulations are often too narrow in focus to address the range of processes and mechanisms that will be necessary to explain adequately how and why manifestations of CD emerge, change overtime and are influenced by children's developmental levels.

Developmental pathways in disruptive child behavior

Developmental sequences in disruptive behavior from childhood to adolescence are traced retrospectively and prospectively in two community samples of boys. Three developmental pathways are distinguished: (a) an early authority conflict pathway, consisting in sequence of stubborn behavior, defiance, and authority avoidance; (b) a covert pathway, consisting of minor covert behaviors, property damage, and moderate to serious forms of delinquency; and (c) an overt pathway, consisting of aggression, fighting, and violence. The overlap among the three disruptive pathways is examined. Those boys who escalated in the overt pathway were more likely to escalate in the covert pathway than boys escalating in the covert pathway showing an escalation in the overt pathway. Escalation in the authority conflict pathway was not associated with escalation in either the overt or the covert pathways. Boys' rate of self-reported delinquency was highest for those in triple pathways (covert-overt-authority conflict) or in certain dual pathways (covert-overt, covert-authority conflict). However, by age 16 the highest rate of offending was displayed by those in the triple pathways. The rate of violent offenses was also highest for those in the triple pathways and for those in the overt and covert pathways. Results from the rate for court petitions largely supported these findings. Lowest rates of offending were observed for boys in the overt and authority conflict pathways. Implications are discussed for clinical practice and future research.

Is attachment theory ready to contribute to our understanding of disruptive behavior problems?

Attachment theory and research have traditionally been subspecialties in infant social development. Recent work has extended the relevance of attachment theory and assessments well into childhood and has established firm ties to work with adults. Many of the same variables associated with the development of disruptive behavior problems also influence the development of attachment. In addition, recent data point to consistent relations between attachment status and disruptive behavior problems. This paper reviews attachment theory, summarizes mechanisms through which attachment might be related to disruptive behavior problems, and discusses the relevance of attachment theory to prevention and therapy. We emphasize the diversity of possible relations between attachment and disruptive behavior problems and the fact that incorporating attachment theory into research on disruptive behavior problems does not mean interpreting every disruptive behavior as attachment related or every attachment-related disruption as serving the same function.

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

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

Children's unique experience of depression: using a developmental approach to predict variation in symptomatology

BACKGROUND

Current clinical knowledge suggests that children can have different types of depressive symptoms (irritability and aggression), but presents no theoretical basis for these differences. Using a developmental approach, the present study sought to test the relationship between developmental level (mental age) and expression of depressive symptoms. The primary hypothesis was that as children's mental age increased, so would the number of internalizing symptoms present.

METHODS

Participants were 252 psychiatric inpatients aged 4 to 16 with a diagnosed depressive disorder. All children were diagnosed by trained clinicians using DSM criteria. Patients were predominantly male (61%) with varied ethnic backgrounds (Caucasian 54%; African American 22%; Hispanic 19%; Other 5%). Children were given an IQ test (KBIT or WISC) while within the hospital. Mental age was calculated by using the child's IQ score and chronological age. Four trained raters reviewed children's records for depressive symptoms as defined by the DSM-IV TR. Additionally, a ratio score was calculated to indicate the number of internalizing symptoms to total symptoms.

RESULTS

Mental age positively correlated (r = .51) with an internalizing total symptom ratio score and delineated between several individual symptoms. Mental age also predicted comorbidity with anxiety and conduct disorders. Children of a low mental age were more likely to be comorbid with conduct disorders, whereas children with a higher mental age presented more often with anxiety disorders. Gender was independently related to depressive symptoms, but minority status interacted with mental age.

CONCLUSION

The results of this study indicate that a developmental approach is useful in understanding children's depressive symptoms and has implications for both diagnosis and treatment of depression. If children experience depression differently, it follows that treatment options may also differ from that which is effective in adults.

Clusters of problem behaviors in adolescents

This study was designed to examine clusters of problem behaviors in a sample from the National Longitudinal Study of Adolescent Health at two time points. The technique employed was a person-oriented approach, cluster analysis. Three clusters were identified, a normal behaviors cluster, a problem behaviors cluster, and a deviant behaviors cluster. The clusters were tested for stability and for their relationships to the demographic variables gender, race, age, and socioeconomic status. The mean values for most of the problem behaviors in the problem behaviors cluster were higher than for those in the normal behaviors cluster and lower than for those in the deviant behaviors cluster. Selling drugs and weapon use distinguished the deviant behaviors cluster from the other two. Different interventions probably will be required to address the needs of those in each of the different clusters.

Delineating the structure of normal and abnormal personality: an integrative hierarchical approach

Increasing evidence indicates that normal and abnormal personality can be treated within a single structural framework. However, identification of a single integrated structure of normal and abnormal personality has remained elusive. Here, a constructive replication approach was used to delineate an integrative hierarchical account of the structure of normal and abnormal personality. This hierarchical structure, which integrates many Big Trait models proposed in the literature, replicated across a meta-analysis as well as an empirical study, and across samples of participants as well as measures. The proposed structure resembles previously suggested accounts of personality hierarchy and provides insight into the nature of personality hierarchy more generally. Potential directions for future research on personality and psychopathology are discussed.

A meta-analytic examination of comorbid hyperactive-impulsive-attention problems and conduct problems

The author quantitatively reviewed prevalence rates, defining features, associated features, developmental trajectory, and etiology to examine 3 taxonomic questions about comorbid hyperactive-impulsive-attention problems (HIA) and conduct problems (CP): Do HIA and CP co-occur randomly? Does comorbid HIA-CP differ from HIA-only and CP-only? Do HIA and CP combine synergistically? Results showed that HIA and CP co-occur at a greater than random rate, that comorbid HIA-CP differs from HIA-only and CP-only in multiple ways, and that there is little evidence that HIA and CP combine synergistically. However, sample type, grouping definition, age, gender, and subtype of disruptive behavior often moderated these findings. Overall, the review suggests that HIA-CP is best conceptualized as an additive combination of HIA and CP rather than as a distinct category.

Rates and patterns of comorbidity of adolescent behavioral syndromes as reported by parents and teachers in a Taiwanese nonreferred sample

OBJECTIVE

To evaluate the rates and patterns of comorbidity between behavioral syndromes in adolescents as reported by parents and teachers. Whether the patterns of comorbidity were "epiphenomenal" was also assessed.

METHOD

Parents of 854 randomly selected students (response rate = 88%) in Taipei in 1996 completed the Child Behavior Checklist; among them, 240 also were randomly selected to have the Teacher's Report Form completed by their teachers. In addition to bidirectional comorbidity rates, odds ratios with and without other comorbid pairs controlled for were estimated via multiple logistic regressions.

RESULTS

High comorbidity rates between behavioral syndromes were found in adolescents as reported both by parents and teachers except for that of Somatic Complaints with other syndromes. When other comorbidity pairs were controlled for, the comorbidity rates between Anxious/Depressed with externalizing syndromes turned out to be epiphenomenal, whereas those between externalizing syndromes remained high for both informants' reports. Attention Problems also remained significantly comorbid with other syndromes in the multiple logistic regressions except for that of Aggressive Behavior in the Teacher's Report Form sample.

CONCLUSION

High comorbidity rates between adolescent behavioral syndromes exist in both parents' and teachers' reports, and it is important to control for the epiphenomenal condition when assessing such comorbidity rates.

Cognitive specificity in internalizing and externalizing problems in community and clinic-referred children

Examined whether cognitive features in Beck's (1967) model of depression and his cognitive content-specificity hypothesis (Beck, Brown, Steer, Eidelson, & Riskind, 1987) are broadband specific features that distinguish internalizing problems from externalizing problems. From a community (n = 389; 196 boys, 193 girls; age M = 9.98, SD = 1.52) and clinic (n = 82; 55 boys, 27 girls; age M = 10.42, SD = 2.91) sample, 4 groups were defined on behavioral measures and then examined on cognitive measures: externalizing only (n = 33), internalizing only (n = 41), comorbid externalizing and internalizing (n = 53), and control (neither externalizing nor internalizing; n = 35). Both the internalizing only and comorbid groups reported significantly more cognitive disturbances (negative cognitive triad, cognitive processing distortions, and "depressive" and "anxious" thought content) than both of the externalizing only and control groups in both the community and clinic samples. The results were not related to either overall level of psychopathology (as reported by mothers) or social desirability in children's reporting. These findings suggest that the cognitive features in Beck's model distinguish internalizing from externalizing problems and add to a growing literature that calls for further conceptual refinement of cognitive models for understanding both narrow-band and broadband syndromes.

Is diagnosis relevant in the hospitalization of potentially dangerous children and adolescents?

OBJECTIVE

This study tests the assumption that psychiatric diagnosis facilitates clinical evaluations of need in emergency care before and after controlling for danger.

METHOD

The data are from structured crisis assessments completed by emergency clinicians in four ethnically diverse locales (N = 653). Clinician-assigned diagnosis was categorized as adjustment, disruptive, mood, psychotic, and other, and a Danger scale score reflected danger to self or others.

RESULTS

Mood and psychotic disorders significantly increased hospital rates in multivariate analyses which controlled for demographic characteristics, site, and danger when relevant. The model with the best fit included both diagnosis and danger.

CONCLUSIONS

Decisions should be linked to verifiable ratings of need and attention to danger, and its measurement should complement the current focus on diagnosis.

Gender differences in children with ADHD, ODD, and co-occurring ADHD/ODD identified in a school population

OBJECTIVE

To examine gender differences among children with disruptive behavior disorders (DBDs) from an ethnically diverse school sample.

METHOD

From 2,984 children, children with attention-deficit/hyperactivity disorder, combined type (ADHD-C) (46 boys, 11 girls), oppositional defiant disorder (ODD) (59 boys, 35 girls), and co-occurring ADHD-C/ODD (76 boys, 27 girls), diagnosed by teacher-rated DSM-IV symptoms, were compared with each other and with 254 controls on teacher ratings of symptoms, social functioning and Achenbach Teacher's Report Form scales.

RESULTS

Children with ADHD-C/ODD received the poorest ratings on all variables. In "pure" groups, children with ODD were rated as learning more, working harder, and being less inattentive than children with ADHD-C; only the ODD group showed more internalizing problems than controls. For ADHD-C and ODD groups, ratings of aggression and some individual symptoms were higher in boys than girls. Girls with ODD were rated as more appropriate and less inattentive, but unhappier and more socially impaired than boys with ODD. Overall, girls received higher peer dislike scores than boys.

CONCLUSIONS

Comorbidity and gender issues affect the correlates of DBDs, with learning problems higher in ADHD-C, internalizing problems associated only with ODD, and greatest impairment for ADHD-C/ODD groups. Despite having similar or less behavioral dysfunction, girls with DBDs may have more social problems than boys with DBDs.

Attention problems versus conduct problems as six-year predictors of problem scores in a national sample

OBJECTIVE

To test the extent to which attention problems, the continuation of early comorbid conduct problems, and overall initial problems account for poor outcome scores on the Child Behavior Checklist and related measures 3 and 6 years after initial assessment.

METHOD

The course of attention and conduct problems was investigated in a nationally representative US sample assessed three times over 6 years, using standardized ratings of attention, conduct, and other problems and gender-specific scores for defining deviance.

RESULTS

Subjects deviant on both attention and conduct problems scored significantly higher on behavior problems at outcome than did those deviant on only attention problems or conduct problems. After controlling for initial conduct problems, initial attention problems made little unique contribution to later conduct problems. Predictive patterns were similar across gender and age groups.

CONCLUSIONS

Both boys and girls who show a combination of attention and conduct problems are at particular risk for the persistence of conduct problems.

Construct validity and predictive utility of the stages of change scale for alcoholics

Recent theory and research suggest that the process of changing addictive behaviors may be conceptualized as a stage phenomenon consisting of precontemplation, contemplation, preparation, action, and maintenance stages. Accurately assessing motivation or commitment to change seems to be a crucial step in matching patients to appropriate interventions. Using the University of Rhode Island Change Assessment Scale (URICA; McConnaughy, Prochaska, & Velicer, 1983), previous research has identified subtypes of outpatient alcoholics based on their attitude toward each of the stages of change. Profiles derived for each subtype roughly corresponded to one of the specific stages of change. The goals of this study were to determine if similar groups could be identified for patients receiving substance abuse treatment in a residential setting and to examine whether these groups would differ on other theoretically relevant variables. Stage of change scale scores for 141 patients entering an alcohol treatment program at a VA domiciliary were submitted to a hierarchical cluster analysis. A two-cluster solution appeared to fit the data best, with group means suggesting the existence of precontemplation and contemplation/action stage groups in this population. The two clusters did not differ on demographic variables, biochemical markers of alcohol consumption, or self-reported awareness of alcohol-related problems. However, participants in the precontemplation cluster reported being less worried about their use, less receptive to help, and having sought out help fewer times in the past. Participants in the contemplation/action cluster also reported greater symptoms of depression and anxiety. Preliminary treatment outcome data for each group are presented, as well as suggestions for treatment matching. Results suggest that the URICA can be used to identify clinically meaningful subtypes of treatment-seeking alcoholics.

Changes in daily mood and self-restraint among undercontrolled preadolescents: a time-series analysis of "acting out"

OBJECTIVE

Acting out among boys with disruptive behavior disorders was investigated by evaluating how changes in their daily moods predicted changes in their behavior.

METHOD

During a 6-week period, 20 preadolescent boys enrolled in day treatment programs rated their mood upon arrival at school, and teachers rated their behavior at the end of the day. Time-series and path-analytic methodologies were used to analyze the data.

RESULTS

The boys did engage in emotional acting out, in that their morning moods predicted their subsequent disruptive behavior, controlling for both individual differences and their behavior the previous day. Boys' mood changes served as a mediator between the intensity of interpersonal conflicts in their lives (with peers and among significant adults) and decrements in their self-restraint. Acting-out behavior was associated with defensive processes, in that boys who reported low subjective distress and whom the teachers rated as high in denial of distress had the strongest links between their moods and behavior. Individual differences in levels of conduct problems, but not hyperactivity, also predicted acting out.

CONCLUSION

Emotional processes and defensive acting out may often be integral aspects of conduct-disordered behavior.