Aggressive behavior in clinically depressed adolescents

Depressive symptoms and anger and aggression in Russian adolescents

Research among adolescents exploring the association between depressive symptoms and aggression has produced inconsistent findings. This study investigated the prevalence of clinically significant (current major depressive episode) and subthreshold depressive symptoms in a general population sample of adolescents from Northern Russia and explored their association with aggression and anger, while controlling for comorbid mental health problems. The sample consisted of 2600 participants, aged 13-17 years (59.5% female; 95.7% ethnic Russian). Symptoms of a current major depressive episode, types of anger and aggression (anger rumination, trait anger, physical, verbal and social aggression) and comorbid problems (posttraumatic stress, alcohol use, anxiety, and hyperactivity/impulsivity) were assessed by means of self-reports. The prevalence of a clinically significant depressive episode in the past month was 3.5%, while for subthreshold depression it was 21.6%. All anger and aggression variables, as well as comorbid problems increased together with increasing levels of depression. The association between overt aggressive behavior and depression was primarily explained by comorbid mental health problems, whereas anger rumination and social aggression had more direct associations with depression, independent of comorbidity. Among adolescents with depression, boys reported higher levels of social and verbal aggression and of anger rumination than girls. The results of this study suggest that interventions aiming to reduce aggressive behavior in adolescents should consider depression and its comorbid conditions.

Longitudinal relationship between depression and antisocial behaviors in Korean adolescents

Background

It is well known that depression and delinquency in adolescents are highly correlated, but longitudinal studies on the causal relationship between them are not active in East Asia compared to in Western culture. In addition, even the results of research on causal models and sex differences are inconsistent.

Objectives

This study examines the longitudinal reciprocal effects between depression and delinquent behavior in Korean adolescents based on sex differences.

Methods

We conducted multiple-group analysis by using an autoregressive cross-lagged model (ACLM). Longitudinal data from 2,075 individuals (2011-2013) were used for analysis. The longitudinal data are from the Korean Children and Youth Panel Survey (KCYPS), and data were used beginning with students at 14 years old (in the second grade of middle school) and tracked them until they were 16 (in the first grade of high school).

Results

Boys' delinquent behaviors at 15 years (the third grade of middle school) affected their depression at 16 years (the first grade of high school). In contrast, girls' depression at 15 years (the third grade of middle school) influenced their delinquent behaviors at 16 years (the first grade of high school).

Discussion

The findings support the failure model (FM) among adolescent boys and the acting-out model (ACM) among girls. The results imply that strategies to effectively prevent and treat delinquency and depression in adolescents must consider sex effects.

Measurement properties of the life history of aggression in adolescents: Data from Morocco, Serbia, Sweden, Vietnam, and the USA

The Life History of Aggression (LHA) is a frequently used scale for assessing trait aggression, but its psychometric properties have not been evaluated among adolescents. The aim of this study was to evaluate the psychometric properties of the LHA among high school students from Morocco, Serbia, Sweden, Vietnam, and the United States of America (USA). The total sample included 4867 adolescents, aged 15-19 years, from Morocco (n = 508), Serbia (n = 1067), Sweden (n = 1570), Vietnam (n = 1401), and the USA (n = 321). A two-factor, nine-item model containing an aggression factor (5 items) and a consequences/antisocial behavior factor (4 items) was created. The two-factor model had an acceptable-to-good model fit for the data for the total sample and all five countries, including gender. Cronbach's alpha (α) was satisfactory across countries. Still, the construct was noninvariant across countries and genders. The LHA with nine items in two subscales showed sound construct validity and internal consistency and can be used for group-level or within-group assessments of trait aggression in adolescents by either gender or country. However, it should not be used for cross-gender or cross-country comparisons due to a lack of measurement invariance.

Confirmatory Factor Analysis of Comorbidity between Depression and Aggression in a Child-Adolescent Community Sample: Nosological, Prognosis and Etiological Implications

Comorbidity between depression and aggression in the child-adolescent population remains a controversial phenomenon. To our knowledge, no longitudinal study using structural equation modeling (SEM) has confirmed whether the relationship between depression and aggression is due to the fact that they share internalizing and externalizing supraordinal factors at the level of the syndrome or is due to the fact that they share common characteristics in relation to an underlying factor at the level of symptoms. We examined longitudinal comorbid relationships in a community sample (N = 251) at three waves ages from 10 to 13 years. The SEM showed that longitudinally, the comorbidity between depression and aggression is due to the fact that they share characteristics of the same underlying factor at the symptom level. These results have implications for the classification, diagnosis, and treatment of comorbidity between depression and aggression in a child-adolescent population.

The Behavioral and Emotional Profile of Pediatric Tourette Syndrome Based on CBCL in a Chinese Sample

BACKGROUND

Tourette syndrome (TS) is a childhood-onset neuropsychiatric disorder that has a unique status of a quintessentially neuropsychiatric condition at the interface of neurology (movement disorder) and psychiatry (behavioral/emotional condition). However, the behavioral and emotional profile has seemed to be neglected in the literature thus far. This study aimed to investigate the behavioral and emotional profile of TS.

METHODS

A total of 124 patients aged 6-16 years with TS were included in this study, including age- and sex-matched health control, attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), and major depressive disorder (MDD) groups. The Child Behavior Checklist (CBCL) was used to screen the behavioral and emotional profile of the TS and other compared groups. The Yale Global Tic Severity Scale (YGTSS) was used to assess TS tic severity. Analysis of variance (ANOVA) was used to investigate the difference between the TS and other compared groups.

RESULTS

The results showed that the eight factors of the CBCL had no association with motor tics, vocal tics, or tic severity (p > 0.05). However, positive correlations were identified between functional impairments (subscales of YGTSS) and thought problems (TP) and rule-breaking behavior (RBB). Based on the eight-factor profile of the CBCL, TS showed a similar profile to MDD but different from ADHD and OCD, which showed similar profiles.

CONCLUSIONS

Based on the assessment of the CBCL of TS, it was found that "pure" TS might show fewer behavioral and emotional problems than OCD, ADHD, and MDD. Similar behavioral and emotional profiles were identified between TS and MDD, but not OCD and ADHD. More attention needs to be paid to the thought problems and rule break problems in the CBCL in the screening stage, which might have a potential influence on the functional impairments of TS.

Transactional patterns of depressive symptoms between mothers and adolescents: The role of emotion regulation

BACKGROUND

Depression is a highly prevalent, debilitating disorder that runs in families. Yet, empirical support for bidirectional mechanisms linking mother-adolescent depression symptoms remains limited. This study examined longitudinal bidirectional relations among emotion regulation (ER) constructs and depressive symptoms among mother-adolescent dyads over time. Pathways for girls and boys were explored separately, given extant research on sex differences in the intergenerational transmission of depression.

METHODS

Adolescent (n = 232; M = 15.02 years, SD = 0.95; 44% female)-mother dyads, drawn from a longitudinal study on the development of risky behaviors, completed annual assessments of depressive symptoms and facets of ER over 4 years. Panel modeling examined lagged and cross-lagged effects of mother-adolescent depressive symptoms and ER constructs over time, in a multigroup model of boys and girls.

RESULTS

Among girls, higher baseline maternal depression scores predicted increased adolescent ER difficulties (std. est. = -.42, p < .001) in turn, predicting increased adolescent depressive symptoms (std. est. = -.33, p = .002) and subsequent maternal ER difficulties (std. est. = .39, p = .002). The indirect effect of maternal depressive symptoms→adolescent ER→adolescent depressive symptoms→maternal ER was significant (ind. eff. = .10, 95% confidence interval [>.001, .19]) for girls, but not boys.

CONCLUSION

Implications for interrupting intergenerational cycles of depressive symptoms and emotion dysregulation are discussed.

What predicts the knowledge of breastfeeding practices among late adolescent girls? evidence from a cross-sectional analysis

INTRODUCTION

Breastfeeding is one of the most effective ways to ensure infant health and survival. Inadequate breastfeeding practices, and knowledge among adolescent mothers have led to unprecedented infant and child morbidity and mortality. Given, the high global prevalence of adolescent mothers it is imperative to understand how the knowledge of breastfeeding practices operates among adolescent girls across different socio-economic settings.

MATERIALS & METHODS

Data was carried out from Understanding the Lives of Adolescents and Young Adults (UDAYA) survey, conducted in 2015-16. Descriptive statistics along with bivariate analysis was done to examine the preliminary results. For analysing the association between the binary outcome variable and other explanatory variables, binary logistic regression method was used. The explanatory variables were educational status of the respondent, media exposure, working status, ever pregnant status (only for married adolescent girls), sex and age of the household head, educational status of the head of the household, caste, religion, wealth index, residence and states.

RESULTS

About 42%, 50%, and 42% of married adolescent girls had knowledge of immediate breastfeeding, yellowish milk, and exclusive breastfeeding respectively. The odds of knowledge about immediate breastfeeding [married-AOR: 1.57; CI: 1.09-2.28 and unmarried-AOR: 1.30; CI: 1.08-1.55], yellowish milk feeding [married-AOR: 2.09; CI: 1.46-3.01 and unmarried-AOR: 1.39; CI: 1.17-1.66], and exclusive breastfeeding [married-AOR: 1.74; CI: 1.2-2.52 and unmarried-AOR: 1.46; CI: 1.22-1.76] were significantly more among adolescent girls aged 19 years old compared to 15 years old girls. Adolescent married and unmarried girls with 10 & above years of schooling were 1.82 times [AOR: 1.82; CI: 1.52-2.18] and 2.69 times [AOR: 2.69; CI: 2.08-3.47] more likely to have knowledge about immediate breastfeeding, 1.74 times [AOR: 1.74; CI: 1.45-2.09] and 2.10 times [AOR: 2.10; CI: 1.68-2.62] more likely to have knowledge about yellowish milk feeding, and 3.13 times [AOR: 3.13; CI: 2.6-3.78] and 3.87 times [AOR: 3.87; CI: 2.95-5.08] more likely to have knowledge about exclusive breastfeeding respectively than girls with no schooling.

CONCLUSION

Breastfeeding practices and interpersonal counselling from elders in the household should be encouraged. Ongoing breastfeeding promotion programs of the government should promote high education of adolescent girls. Mass media interventions should be encouraged.

A New Decade of Healthy People: Considerations for Comparing Youth Physical Activity Across 2 Surveillance Systems

BACKGROUND

Healthy People 2030 includes objectives to increase meeting the aerobic physical activity guideline for ages 6-13 years (of ages 6-17 y, monitored by National Survey of Children's Health [NSCH]) and grades 9 to 12 (mostly aged 14-18+ y, monitored by Youth Risk Behavior Survey [YRBS]). This study compares methodologies, prevalence, and patterns of meeting the guideline, particularly for overlapping ages 14-17 years.

METHODS

Nationally representative surveys, 2016-2017 NSCH (adult proxy report, 6-17 y) and 2015 and 2017 YRBS (self-report, grades 9-12), assess meeting the guideline of ≥60 minutes of daily moderate to vigorous physical activity. Prevalence and odds ratios were estimated by age group and demographics.

RESULTS

For youth aged 14-17 years, 17.4% (95% confidence interval [CI], 16.1-18.7; NSCH) and 27.0% (95% CI, 25.6-28.5; YRBS) met the guideline. 25.9% (95% CI, 24.8-27.2) aged 6-13 years (NSCH) and 26.6% (95% CI, 25.3-28.0) in grades 9 to 12 (YRBS) met the guideline. Across surveys, fewer females (P < .001) and Asian youth (P < .001 except among NSCH 14-17 y) met the guideline.

CONCLUSIONS

Neither methodology nor estimates for meeting the aerobic guideline are similar across surveys, so age continuity between juxtaposed estimates should not be assumed by magnitude nor age for separate Healthy People 2030 youth physical activity objectives.

From Exposure to Violence between Mother and Her Intimate Partner to Suicidality Experienced by Urban Adolescents in Chicago's Southside

Although the relationship between exposure to intimate partner violence and youths’ psychological and other wellbeing has been widely studied, there is limited research about how youths’ exposure to violence between mother and her intimate partner may be related to youth psychological wellbeing. The study used a sample of urban adolescents in Chicago Southbound to examine whether youths’ exposure to verbal conflict between mother and her intimate partner is related to their suicidality and whether youth depression and aggression may be in between such a linkage. Our findings indicated that one-third of the youth had suicidal thoughts or suicidal/self-hurting attempts. Youths’ exposure to verbal conflict between mother and her intimate partner was associated with their depressive and aggressive symptoms, and depressive symptoms subsequently were linked to suicidality. The findings also showed that youth depressive symptoms and aggressive symptoms were positively correlated, which may influence their associations with suicidality. We concluded that youth exposure to parental intimate partner violence, even comparatively mild forms such as a verbal conflict between mother and her intimate partner, may increase their risk of suicidality by worsening psychological wellbeing. The findings highlight the importance of tackling youth suicidality risks while accounting for their exposure to intimate partner violence including verbal conflicts between parents.

Pathways from health beliefs to treatment utilization for severe depression

BACKGROUND

Untreated depression is associated with negative behavioral, psychosocial, and physical outcomes leading to socioeconomic costs, disability, and premature mortality. Research has not yet fully developed intervention models to increase the utilization of mental health treatments. The objective of the current study was to characterize the pathways linking health beliefs to treatment utilization among depressed young adults.

METHODS

Data were collected in 2017 from 53,760 college students at 54 universities in the United States. Among the respondents, 5,343 screened positive for moderately severe to severe depression. Becker's Health Belief Model (HBM) was the guiding theoretical paradigm. Confirmatory factor analysis and structural equation modeling (SEM) were conducted to elucidate treatment-seeking behavior based on health beliefs (perceived severity, perceived benefit, perceived barriers, self-efficacy, and cues-to-action) while controlling for relevant sociodemographic covariates.

RESULTS

Depression treatment utilization was significantly associated with all domains of the HBM. SEM parameter estimates indicated that higher levels of perceived severity, self-efficacy, and cues-to-action were associated with greater depression treatment utilization, whereas perceived benefits and perceived barriers were associated with lower depression treatment utilization.

CONCLUSIONS

The HBM may be useful to predict the frequency of seeking treatment by individuals for depression. However, individualized intervention strategies targeting different aspects of the HBM are needed to promote help-seeking behaviors in young adults with depression.

Stress-induced aggression in heterozygous TPH2 mutant mice is associated with alterations in serotonin turnover and expression of 5-HT6 and AMPA subunit 2A receptors

BACKGROUND

The contribution of gene-environment interactions that lead to excessive aggression is poorly understood. Environmental stressors and mutations of the gene encoding tryptophan hydroxylase-2 (TPH2) are known to influence aggression. For example, TPH2 null mutant mice (Tph2-/-) are naturally highly aggressive, while heterozygous mice (Tph2+/-) lack a behavioral phenotype and are considered endophenotypically normal. Here we sought to discover whether an environmental stressor would affect the phenotype of the genetically 'susceptible' heterozygous mice (Tph2+/-).

METHODS

Tph2+/- male mice or Tph2+/+ controls were subjected to a five-day long rat exposure stress paradigm. Brain serotonin metabolism and the expression of selected genes encoding serotonin receptors, AMPA receptors, and stress markers were studied.

RESULTS

Stressed Tph2+/- mice displayed increased levels of aggression and social dominance, whereas Tph2+/+ animals became less aggressive and less dominant. Brain tissue concentrations of serotonin, its precursor hydroxytryptophan and its metabolite 5-hydroxyindoleacetic acid were significantly altered in all groups in the prefrontal cortex, striatum, amygdala, hippocampus and dorsal raphe after stress. Compared to non-stressed animals, the concentration of 5-hydroxytryptophan was elevated in the amygdala though decreased in the other brain structures. The overexpression of the AMPA receptor subunit, GluA2, and downregulation of 5-HT6 receptor, as well as overexpression of c-fos and glycogen-synthase-kinase-3β (GSK3-β), were found in most structures of the stressed Tph2+/- mice.

LIMITATIONS

Rescue experiments would help to verify causal relationships of reported changes.

CONCLUSIONS

The interaction of a partial TPH2 gene deficit with stress results in pathological aggression and molecular changes, and suggests that the presence of genetic susceptibility can augment aggression in seemingly resistant phenotypes.

The Influence of Internalizing Symptoms and Emotion Dysregulation on the Association Between Witnessed Community Violence and Aggression Among Urban Adolescents

The current cross-sectional study examined whether internalizing (i.e. anxiety and depressive) symptoms and/or emotion dysregulation moderated the association between witnessed community violence and aggressive behavior. Participants were 180 predominantly African American adolescents (62% girls; M age = 15.87 years, SD = 1.19 years) from a high school located in an urban community in the United States. Approximately 95% of adolescents reported having witnessed at least one violent act during their lifetimes, with many endorsing repeated exposure to severe acts of community violence. Results indicated that emotion dysregulation exacerbated the association between witnessed community violence and aggression. A quadratic effect of anxiety symptoms also moderated this association, such that witnessed community violence was linked to aggression at low and high, but not moderate, levels of anxiety symptoms. In contrast, a quadratic effect of depressive symptoms was uniquely related to aggression, regardless of witnessed community violence. Directions for future research and implications for practice are reviewed.

Modifiable factors affecting inpatient violence in an acute child and adolescent psychiatric unit: A 16-year retrospective study

Violent incidents in acute inpatient units for children and adolescents are a major and persistent problem. The demographic, clinical, and modifiable (environmental-organizational) risk factors that affect inpatient violence in an Acute Child and Adolescent Psychiatric Unit were investigated via a retrospective study. Data were collected from nursing and medical reports and the unit's census and included 100 days per year for 16 years. Incidents of violence and assault types were recorded, and variables such as the diagnostic category of assailants, total number of patients, and staffing factors during the incident were examined. Of the 2390 violent incidents recorded, 50% were attributed to cases of physical violence towards another patient, 17% to physical violence towards nursing staff, 19% to physical violence towards self and 14% to destruction of property. According to the final multivariable model, for each additional patient in the unit, the risk of a violent event increased by 9.51%; for each additional offender patient, the risk increased by 14.06%; the number of assistant nurses was associated with a 25.03% increased risk; and, after 2006, the risk increased by 68.99%. The most significant factor associated with a 59.98% decreased risk was the total number of nursing staff. All variables significantly and independently contributed to the model. Acute inpatient psychiatric units with a small number of hospitalized patients, adequate, well-trained and specialized nursing staff, and the hospitalization of different types of patients in separate wards or units are expected to facilitate a reduction in the frequency of violent incidents.

Does Context Matter? A Multi-Method Assessment of Affect in Adolescent Depression Across Multiple Affective Interaction Contexts

This study utilized a multi-method approach (self-reported affect, observed behavior, and psychophysiology) to investigate differences between clinically depressed and non-depressed adolescents across three different affective interaction contexts with their parents. 152 adolescents (52 males, 14-18 y.o.), and their parents, participated in a laboratory session in which they discussed positive and negative aspects of their relationship, and reminisced on positive and negative memories. We found that across contexts depressed adolescents exhibited higher negative affect and behaviors, lower positive behaviors, and greater autonomic and sympathetic activity. Context specific findings indicated that depressed adolescents 1) exhibited greater persistence of negative affect and dysphoric behavior across the sequence of tasks, whereas these phenomena declined amongst their non-depressed peers, 2) depressed adolescents had greater increases in aggressive behaviors during negative interactions, and 3) depressed adolescents had greater parasympathetic withdrawal during negative interactions, while this response characterized the non-depressed group during positive interactions.

Differential Effects of Mental Health Problems Among Truant Youths

Research indicates at-risk youth are more likely to experience emotional and psychological problems. Young people who are often truant from school represent a group of at-risk youth, but one for which mental health issues are understudied. This study examined heterogeneity of mental health problems among a sample of 300 truant adolescents using latent class analysis (LCA). LCA indicated the sample of truants was best represented by four latent subgroups of youth with low mental health problems; high depression, low mania; high mania, low depression; and high depression and mania. These subgroups were examined in relation to sociodemographic and psychosocial measures at baseline and after truancy offenses. Results indicated general and unique differences in these covariates across the four latent classes. Service and practice implications of better understanding mental health issues of truant youth are discussed.

Mental Illness and Juvenile Offenders

Within the past decade, reliance on the juvenile justice system to meet the needs of juvenile offenders with mental health concerns has increased. Due to this tendency, research has been conducted on the effectiveness of various intervention and treatment programs/approaches with varied success. Recent literature suggests that because of interrelated problems involved for youth in the juvenile justice system with mental health issues, a dynamic system of care that extends beyond mere treatment within the juvenile justice system is the most promising. The authors provide a brief overview of the extent to which delinquency and mental illness co-occur; why treatment for these individuals requires a system of care; intervention models; and the juvenile justice systems role in providing mental health services to delinquent youth. Current and future advancements and implications for practitioners are provided.

Do girls with depressive symptoms exhibit more physical aggression than boys? A cross sectional study in a national adolescent sample

BACKGROUND

The relationship between depression and aggressive behaviors in adolescents has previously been reported in clinical and epidemiological studies. However, there is conflicting evidence concerning the effect of gender on this relationship. This study tested whether the link between depressive symptoms and physical aggression differed between boys and girls in a large community-based sample of adolescents.

METHODS

A cross-sectional sample of adolescents aged 15-19 (N = 6,677) was studied within the 2007 ESPAD national survey. Depressive symptoms were assessed using the Adolescent Depression Rating Scale. We distinguished adolescents with subthreshold levels of depressive symptoms and adolescents with clinically significant levels of depressive symptoms. Physical aggressive behaviors in the last year were reported using items from the Antisocial Behavior Scale.

RESULTS

After adjusting for confounding variables, the odds-ratio between depressive symptoms and physical aggressive behaviors was around 1.4. This relationship was stronger for girls than for boys in presence of clinically significant levels of depressive symptoms, but did not differ between the genders in the case of subthreshold levels of depressive symptoms.

CONCLUSIONS

Girls with severe depressive symptoms were more likely to present physical aggressive behaviors than boys. Future studies will be needed to explore the role of irritability in these differences.

Aggression in children with behavioural/emotional difficulties: seeing aggression on television and video games

BACKGROUND

Mental health professionals are often asked to give advice about managing children's aggression. Good quality evidence on contributory environmental factors such as seeing aggression on television and in video games is relatively lacking, although societal and professional concerns are high. This study investigated possible associations between seeing aggression in such media and the aggressive behaviour of children attending specialist outpatient child and adolescent mental health services (CAMHS).

METHODS

In this mixed methods study, forty-seven British children aged 7-11 years with behavioural/emotional difficulties attending CAMHS and their carers participated in a survey; twenty purposively-selected children and a parent/carer of theirs participated in a qualitative study, involving semi-structured interviews, analysed using the Framework Analysis Approach; findings were integrated.

RESULTS

Children attending CAMHS exhibit clinically significant aggression, of varying types and frequency. They see aggression in multiple real and virtual settings. Verbal aggression was often seen, frequently exhibited and strongly associated with poor peer relationships and low prosocial behaviour. Children did not think seeing aggression influences their own behaviour but believed it influences others. Carers regarded aggression as resulting from a combination of inner and environmental factors and seeing aggression in real-life as having more impact than television/video games.

CONCLUSIONS

There is yet no definitive evidence for or against a direct relationship between aggression seen in the media and aggression in children with behavioural/emotional difficulties. Future research should take an ecological perspective, investigating individual, developmental and environmental factors. Carers, professional organisations and policy makers should address aggression seen in all relevant area of children's lives, primarily real-life and secondly virtual environments.

[The link between aggressive behavior and depression in adolescence. A cross-sectional study conducted in the psychiatric emergency unit at the Sainte-Anne hospital]

INTRODUCTION

The link between depression and aggressive behavior in adults has been found in many studies. In adolescents, this relationship is still controversial. Several studies point out that irritability is a key symptom in adolescent depressed. Few studies have analyzed precisely the kind of aggressive behavior. This study sets out to assess the relationship between aggressive behavior and depressive affects in adolescents. We also pay attention in this population to hopelessness feelings, anxiety, global functioning and the type of aggressive behavior.

METHOD

This is a descriptive and observational cross-sectional study. Data was collected from 49 successive adolescents admitted for a 24-hour evaluation in the emergency department of the Sainte-Anne psychiatric hospital. The inclusion period was from February to April 2012, with age limits between 15 and 18. For each patient, the clinician completed with the parents or other caregivers the Modified Overt Aggressive Scale (MOAS) searching for existence of aggressive behavior in the week prior to the consultation. The population was divided into two groups: P- group when the MOAS score was < 3 and the P+ group when the MOAS score was ≥ 3. The Global Assessment of Functioning Scale and Adolescent Depression Rating Scale for clinicians (ADRSc) were also completed. Each patient completed the self-report Buss-Perry Aggression Questionnaire (QA), the Beck Hopelessness scale and the Adolescent Depression Rating Scale for patients (ADRSp).

RESULTS

Forty-nine adolescents with a median age of 16 years and 4 months participated. The first reason for consultation was depressive symptoms, followed by disruptive behavior. The analysis was conducted on 39 questionnaires. The demographic profile of the two groups was similar. We did not find any significant difference between the groups P+ and P- on ADRSc scores and secondary criteria. However, we found higher scores in the QA in the more depressed patient, especially a higher hostility score in this sample. In the subgroup analysis: as expected self-aggressive behavior was associated with a higher depression score, more hospitalization and a poor global functioning score. Surprisingly, the patients who showed physical aggression against others had a better prognosis and lower depression scores.

DISCUSSION

The study did not conclude on the link between aggressive behavior and depression in this population. The adolescent hostility appears more characteristic of depression compared to other dimensions of aggressivity (anger, verbal aggression, physical aggression) in adolescents. Physical aggression against others appeared not only less typical in depression but was also associated with a better global functioning. Clinicians should pay particular attention to the kind of aggressive behavior in clinical evaluations of adolescents in an emergency context.

Predicting borderline personality disorder symptoms in adolescents from childhood physical and relational aggression, depression, and attention-deficit/hyperactivity disorder

Developmental cascade models linking childhood physical and relational aggression with symptoms of depression and attention-deficit/hyperactivity disorder (ADHD; assessed at ages 10, 11, 12, 13, and 14) to borderline personality disorder (BPD) features (assessed at age 14) were examined in a community sample of 484 youth. Results indicated that, when controlling for within-time covariance and across-time stability in the examination of cross-lagged relations among study variables, BPD features at age 14 were predicted by childhood relational aggression and symptoms of depression for boys, and physical and relational aggression, symptoms of depression, and symptoms of ADHD for girls. Moreover, for boys BPD features were predicted from age 10 ADHD through age 12 depression, whereas for girls the pathway to elevated BPD features at age 14 was from depression at age 10 through physical aggression symptoms at age 12. Controlling for earlier associations among variables, we found that for girls the strongest predictor of BPD features at age 14 was physical aggression, whereas for boys all the risk indicators shared a similar predictive impact. This study adds to the growing literature showing that physical and relational aggression ought to be considered when examining early precursors of BPD features.

Aggressiveness across development and suicidal behavior in depressed patients

The objective of this study was to determine differences in the pathway of aggressiveness across development between depressive subjects and normal controls, and to examine males and females separately with regard to level of aggression and suicidal behavior among depressed subjects. Participants were classified into 5 groups: depressed suicide attempters (DSA; n = 339), depressed non-suicide attempters (DNSA; n = 92), psychiatric controls who had attempted suicide (PSA; n = 188), psychiatric controls who had not attempted suicide (PNSA; n = 222), and normal controls (NC; n = 532). The level of aggressiveness across development in the different groups was examined using a 5 (DSA vs. DNSA vs. PSA vs. PNSA vs. NC)×3 (Childhood, Adolescence, and Adulthood) MANCOVA. Adjusted and separate models for males and females were conducted. Depressed subjects differed in severity of aggressiveness. The level of aggressiveness in individuals in the NC group remained stable across development, while subjects in the DSA and DNSA groups showed significantly higher levels of aggressiveness. This finding was also observed in subjects of the PSA and PNSA groups. The level of aggressiveness in males with depression significantly increased over time. In women, increasing levels of aggressiveness across development were only observed in depressed suicide attempters. Limitations of this study included use of semi-structured interview for the assessment of risk factors. We found significant differences in severity and in the pathway of aggressiveness across development between depressive subjects and normal controls. In addition, sex differences regarding level of aggression and suicidal behavior among depressed subjects were found.

Depression

This article reviews the assessment and treatment for depression in children and adolescents, emphasizing the implementation of evidence-based treatments into clinical care. Past trials of antidepressant medications are reviewed, as well as the clinical use of antidepressants and pharmacologic strategies for refractory illness or in the context of comorbid conditions. Clinicians who treat youth now have a body of empiric research to help guide treatment decisions; however, personalized treatment based on associated symptoms, comorbid conditions, contextual factors, and psychiatric history is essential. Further research is needed in the pharmacologic treatment of depressed youth, including expanding the study of non-SSRI antidepressants, augmentation and adjunctive strategies, and treatment in patients with comorbid conditions.

Understanding inpatient violence in a New Zealand child and adolescent psychiatric setting

This paper describes the rate of violent episodes at a youth psychiatric unit, identifies significant clinical and demographic differences between service users who had admissions with violent episodes and those who did not, and describes characteristics of violent incidents, including antecedents, consequences, victim type, and severity of violence. A retrospective file audit over a 2-year period reviewed 303 admissions. Characteristics of violent incidents (n = 242) and service users (violent/non-violent) were recorded. Of 263 service users, 21.7% exhibited violent behaviour. Significant differences between admissions with and without violent episodes were found in terms of ethnicity, legal status, length of admission, and diagnosis. Staff were the most frequent victims and less severe incidents were most common. The most frequent antecedents to violence were positive symptoms of psychosis, hostility, and agitation, while the most common consequences were seclusion, physical restraint and 'as-required' medication. This study has identified that violent incidents are a common and significant issue. The findings might help staff in reviewing current management approaches. Future areas of study have been identified.

History of suicide attempt in male substance-dependent inpatients and relationship to borderline personality features, anger, hostility and aggression

The aim of this study was to investigate the relationship between severity of borderline personality features and history of suicide attempt (HSA) in male substance-dependent inpatients and the effect of anger, hostility and aggression on this relationship. Further, the effect of some variables that may be related to suicide and/or borderline personality, such as age at inception of regular substance use, substance of dependence (alcohol/drug), depression, and both state and trait anxiety, were controlled. Participants were 200 consecutively admitted male substance-dependent inpatients. Patients were investigated with the Borderline Personality Inventory (BPI), the Buss-Perry Aggression Questionnaire (AQ), the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI). Among substance-dependent inpatients, 33.0% (n=66) were identified as the group with HSA. Mean scores employment status, marital status and duration of education did not differ between groups, whereas current age and age at onset of regular substance use were lower in group with HSA. Mean scores of BPI, AQ and its subscales (anger, hostility and physical/verbal aggression), BDI and STAI were higher in the HSA group. In addition, the rates of drug dependency and borderline personality disorder were higher in this group. The severity of borderline personality symptoms was highly correlated with subscales of the AQ, depression and anxiety, whereas it was negatively correlated with age at onset of regular substance use. The severity of anger and borderline personality features predicted HSA in the logistic regression model. Results suggest that, to reduce the risk of suicide attempt among substance-dependent patients, the feeling of anger must be the target of evaluation and treatment among those with borderline personality features.

Gender differences in trait aggression in young adults with drug and alcohol dependence compared to the general population

OBJECTIVE

Data in gender differences in aggression among alcohol and drug dependent subjects are lacking, and no published data are available about gender differences among various subtypes of substance using populations. The goal of this cross-sectional study was to investigate gender differences with regard to types of trait aggression in substance dependent young populations (age: 20-35 years) compared to the general population.

METHODS

Subjects were selected from two clinical samples with a diagnosis of alcohol and drug dependence as well as from a representative sample of the general population. Trait aggression was measured by the four individual subscales of the Buss Perry Aggression Questionnaire (physical-PA, verbal aggression-VA, hostility-H and anger AN) whereas alcohol and drug use were characterized by the AUDIT and EuroADAD scales, respectively.

RESULTS

Alcohol and drug dependent subjects showed higher severity on all four subscales of trait aggression compared to the general population. The male-female difference was the highest in the cannabis group. General Linear Model analysis for PA indicated a significant main effect of gender (higher PA for males, p=0.034) with no interaction between substance dependence and gender. For VA, no main effect or interaction for gender was found. Effect sizes for gender difference indicated that while males and females were similar in the control group in the severity in H and A, the level of H and AN was substantially higher in females than in males in the clinical group. These differences between the two genders reached statistical significance in the marijuana group, where female subjects showed a significantly higher severity in these two domains.

CONCLUSIONS

Compared to the normal sample chronic substance use is associated with higher scores on certain factors of trait aggression, including hostility and anger, in females than in males. Our data suggest that aggression in substance dependent females is more provocable by chronic use of alcohol and drugs than in males.

Psychopharmacologic control of aggression and violence in children and adolescents

Aggression in children and adolescents is commonly displayed in the community and is even more commonly seen in clinical settings. As symptoms of an underlying disorder, aggressive behaviors should be comprehensively evaluated, and developmental, medical, and substance-use disorders should be identified and treated. This article reviews the most common psychiatric conditions associated with aggression and suggests appropriate psychopharmacologic interventions. Tables with recommended agents for each psychiatric disorder, as well as dosing ranges for each agent, are included.

Prediction of restraints among youth in a psychiatric hospital: application of translational action research

This study extends a translational action research program by applying a theoretically based measure of risk in predicting incidents of restraint among children and adolescents in a secure psychiatric hospital. Youth inpatients (N = 149, aged 5-17 years) were assessed at intake for the presence of selected individual and contextual risk factors, and their involvement in critical incidents was tracked (i.e., number of episodes in which restraint was applied) for the remainder of their hospitalization. Models including history of aggression or history of previous placements as well as combined models including several individual and contextual factors significantly predicted the likelihood of a youth becoming involved in at least one restraint. Unique predictors of restraint involvement included history of aggression against adults and history of previous psychiatric hospitalizations. None of the variables assessed predicted the extent of a youth's restraint involvement. The implications of these findings are discussed with respect to future research and empirically informed practice with high-risk youth.

Trait anger, anger expression, and suicide attempts among adolescents and young adults: a prospective study

Previous studies of the relationship between anger, anger expression, and suicidal behavior have been largely cross-sectional and have yielded mixed findings. In a prospective, naturalistic study, we examined how trait anger and anger expression influenced the likelihood of suicide attempts among 180 adolescents followed for up to 13.3 years after discharge from an inpatient psychiatry unit. Results showed that higher trait anger and anger expressed outwardly over the follow-up was related to increased likelihood of suicide attempts among boys. For girls, trait anger and both the inward and outward expression of anger moderated the risk for suicide attempts associated with major depression. These results are interpreted in light of theory regarding behavioral activation and behavioral inhibition systems.

Does controlling for comorbidity matter? DSM-oriented scales and violent offending in Chicago youth

Mental health problems have long been linked to antisocial behaviors. Despite an impressive body of literature demonstrating this relationship and claims that comorbidity matters, few studies examine comorbidity using multiple distinct mental health indicators, with most studies instead adopting single or composite mental health measures. This study tested separate and comorbid effects of five DSM-oriented mental health issues on self-reported violence using a community-based sample of Chicago youths from the Project on Human Development in Chicago Neighborhoods. Moreover, it utilized both primary caregiver and youth self-reports of psychopathology across four developmental stages of childhood and adolescence. When examined separately, the results indicated affective/depressive, anxiety, attention deficit hyperactivity, and oppositional defiant/antisocial personality problems independently predicted violence. When considering comorbidity, however, only oppositional defiant and antisocial personality problems significantly predicted violence at any stage, regardless of informant type. Implications for future studies and policy are discussed.

Covariation of self- and other-directed aggression among inpatient youth: continuity in the transition to treatment and shared risk factors

Although other- and self-directed aggression covary in very high-risk youth, these forms of aggression infrequently are studied simultaneously. Understanding better their covariation is an important task for improving services to high-risk youth. In this study, data from the clinical records of 476 youth admitted to secure inpatient treatment were analyzed to examine relations among self- and other-directed aggression exhibit before and during inpatient treatment. Analyses tested the hypotheses that self- and other-directed aggression would tend to covary and display continuity from pre-treatment to in-treatment. Also tested were the hypotheses that youth with histories of co-occurring self- and other-directed aggression would show the highest levels of aggression during treatment and the greatest degree of personal and contextual risk on entering treatment. These hypotheses were largely supported. Exploratory analyses revealed interesting discontinuities in aggression (aggression emitted only before or during treatment) with critical implications for research and practice with youth receiving clinical care, especially those in institutional placements.

The role of violent media preference in cumulative developmental risk for violence and general aggression

The impact of exposure to violence in the media on the long-term development and short-term expression of aggressive behavior has been well documented. However, gaps in this literature remain, and in particular the role of violent media exposure in shaping violent and other serious antisocial behavior has not been investigated. Further, studies of violent media effects typically have not sampled from populations with confirmed histories of violent and/or nonviolent antisocial behavior. In this study, we analyzed data on 820 youth, including 390 juvenile delinquents and 430 high school students, to examine the relation of violent media use to involvement in violence and general aggression. Using criterion scores developed through cross-informant modeling of data from self, parent/guardian, and teacher/staff reports, we observed that childhood and adolescent violent media preferences contributed significantly to the prediction of violence and general aggression from cumulative risk totals. Findings represent a new and important direction for research on the role of violent media use in the broader matrix of risk factors for youth violence.

Physical aggression during admission to a child and adolescent inpatient unit: predictors and impact on clinical outcomes

OBJECTIVE

Aggressive behaviour is common in young people admitted to child and adolescent inpatient services. Little is known about how physical aggression during admission influences patient outcomes. The aim of the present study was to identify predictors of aggression in a child and adolescent inpatient unit and examine differences in clinical outcomes between aggressive and non-aggressive patients.

METHOD

Episodes of aggression occurring within a child and adolescent inpatient unit were prospectively documented between October 2004 and December 2005. Patient factors (demographics, diagnoses, clinical history) were examined as predictors of aggression. Outcomes for admissions in which more than one episode of physical aggression occurred were compared to those in which no aggression occurred. Outcomes assessed were changes in symptom severity (as rated by the Health of the Nation Outcome Scales for Children and Adolescents) length of stay, and initiation of medications.

RESULTS

A total of 134 patients were admitted during the study period (61.9% female, mean age=13.8 years, SD=2.9); 31 patients (23.1%) exhibited physical aggression during admission and 20 of these exhibited more than one episode of physical aggression. Factors that predicted persistent physical aggression included history of aggression, use of medications at presentation and absence of self-harm. Persistent aggression was also associated with increased length of stay, but did not compromise improvements in clinical symptom ratings between admission and discharge or lead to increased medication prescribing.

CONCLUSION

Contrary to hypotheses and existing research, aggression during admission does not appear to be a barrier to clinical improvement. Further research is necessary to clarify how aggressive children can receive the most benefit from inpatient admission while minimizing the risks to the patient and those around them.

Rage attacks and aggressive symptoms in Japanese adolescents with tourette syndrome

OBJECTIVE

This study was conducted to explore possible causes of rage attacks as well as clinically significant aggressive symptoms in Japanese adolescents with Tourette syndrome (TS).

METHODS

The subjects included 29 adolescents (23 males, 6 females; mean age: 13.5+/-3.7 years). Eighteen subjects (62.1%) were diagnosed with TS only, 11 (37.9%) with TS and comorbidities, including attention-deficit/hyperactivity disorder and obsessive-compulsive disorder. Parents completed the Child Behavior Checklist. Clinically significant aggressive symptoms were assessed using two pilot tools, the Rage Screen and Questionnaire and the Clinical Rating of Aggression.

RESULTS

Thirteen subjects (44.8%) were judged to have clinically significant aggressive symptoms, according to the Clinical Rating of Aggression. Twelve met criteria for recurrent rage attacks, according to the Rage Screen and Questionnaire. Between the 13 aggressive and 16 non-aggressive subjects, no significant differences were found in age, gender, psychiatric comorbidities, or concurrent medication. Child Behavior Checklist ratings to compare 11 aggressive and 12 non-aggressive subjects <16 years of age revealed elevated t-test scores on the anxious/depressed, thought problems, aggressive, internalizing, externalizing subscales, and total scale in the aggressive group versus the non-aggressive group.

CONCLUSION

Rage attacks and clinically significant aggressive symptoms are common problems in Japanese TS youth. Psychiatric morbidity appears associated with impulsive-aggressive symptoms. Treatment implications from these findings need to be explored further.

Meta-analysis of aggression and/or hostility-related events in children and adolescents treated with fluoxetine compared with placebo

This meta-analysis assessed aggression and/or hostility-related events in children and adolescents treated with fluoxetine (n = 376) compared with placebo (n = 255). Aggression and/or hostility-related events were identified in 2.1% of fluoxetine versus 3.1% of placebo-treated patients (p = 0.588). This analysis fails to support an association between fluoxetine treatment and increased risk of aggression and/or hostility-related events in children and adolescents compared with placebo.

Sequelae of Aggression in Acutely Suicidal Adolescents

The consequences of aggression on problem course and suicide risk were examined in 270 acutely suicidal adolescents (ages 12-17 years; 184 girls). Participants were assessed during psychiatric hospitalization (T1), 6-months post-hospitalization (T2), and 15 or more months post-hospitalization (T3). Study variables included self- and parent-reported aggression; self-reported internalizing symptoms, suicidal ideation, suicide attempt, and adverse events; and clinician-rated suicidal behavior. Aggression was not directly related to suicide attempt concurrently or prospectively. However, among more aggressive youth, internalizing symptoms were more predictive of T3 suicide attempt than among less aggressive youth. T1 aggression predicted aggressive incidents and the likelihood of incarceration prior to T3. Two-level hierarchical linear modeling indicated that self-reported aggression and internalizing problems were linked in terms of severity and rates of decline over time. Overall, parent-reported aggression was negatively associated with suicidal ideation. Findings highlight (a) the continuity and consequences of aggression, (b) a possible role of aggression in worsening suicide risk factors and potentiating suicide attempt, and (c) the importance of ongoing research on subtypes of suicidal adolescents.

The association of parental alcohol abuse and depression with severe emotional and behavioural problems in adolescents: a clinical study

BACKGROUND

Earlier studies have indicated associations between parental psychiatric problems, such as depression, and substance abuse and adolescent problems.

AIMS

This study aimed to determine whether parental psychiatric problems are associated with problems and problem behaviour in adolescents in a clinical sample.

METHODS

The study subjects were 70 outpatient adolescents (age 13-18 years, boys 30%) and their parents. The adolescents were assessed using the structural clinical interview for DSM-III-R (SCID) and a semi-structured questionnaire, and the parents were interviewed using a semi-structured questionnaire.

RESULTS

Maternal alcohol abuse and depression were associated with serious problems, especially among girls, and paternal alcohol abuse was associated with adolescent health-compromising behaviour. Maternal depression and alcohol abuse had no association with adolescent health-compromising behaviour. Maternal depression without alcohol abuse was associated with the diagnosis of major depressive disorder in adolescents, but not with other adolescent problems, while paternal depression without alcohol abuse was not associated with any adolescent problems.

CONCLUSIONS

Despite the small study sample, these findings indicate that parental psychiatric problems and alcohol abuse are correlated with adolescent psychological problems and should be considered and assessed when assessing adolescents.

The prevalence and correlates of DSM-IV intermittent explosive disorder in the National Comorbidity Survey Replication

CONTEXT

Little is known about the epidemiology of intermittent explosive disorder (IED).

OBJECTIVE

To present nationally representative data on the prevalence and correlates of DSM-IV IED.

DESIGN

The World Health Organization Composite International Diagnostic Interview was used to assess DSM-IV anxiety disorders, mood disorders, substance use disorders, and impulse control disorders.

SETTING

The National Comorbidity Survey Replication, a face-to-face household survey carried out in 2001-2003.

PARTICIPANTS

A nationally representative sample of 9282 people 18 years and older.

MAIN OUTCOME MEASURE

Diagnoses of DSM-IV IED.

RESULTS

Lifetime and 12-month prevalence estimates of DSM-IV IED were 7.3% and 3.9%, with a mean 43 lifetime attacks resulting in 1359 dollars in property damage. Intermittent explosive disorder-related injuries occurred 180 times per 100 lifetime cases. Mean age at onset was 14 years. Sociodemographic correlates were uniformly weak. Intermittent explosive disorder was significantly comorbid with most DSM-IV mood, anxiety, and substance disorders. Although the majority of people with IED (60.3%) obtained professional treatment for emotional or substance problems at some time in their life, only 28.8% ever received treatment for their anger, while only 11.7% of 12-month cases received treatment for their anger in the 12 months before interview.

CONCLUSIONS

Intermittent explosive disorder is a much more common condition than previously recognized. The early age at onset, significant associations with comorbid mental disorders that have later ages at onset, and low proportion of cases in treatment all make IED a promising target for early detection, outreach, and treatment.

Major depressive disorder in adolescents: family psychiatric history predicts severe behavioral disinhibition

BACKGROUND

Major Depressive Disorder (MDD) becomes increasingly prevalent during adolescence and is associated with substantial psychiatric comorbidity and psychosocial impairment. The marked behavioral heterogeneity evident among adolescents with MDD suggests the possibility of distinct subtypes. This study was designed to determine whether family psychiatric histories differ between groups of MDD adolescents defined by the presence or absence of severe behavioral disinhibition.

METHODS

Adolescents with MDD (n = 71) completed the Buss-Durkee Hostility Inventory--Adapted, Adolescent Aggressive Incidents Interview (AAII), Measure of Aggression, Violence, and Rage in Children, Diagnostic Interview Schedule for Children, Suicidal Ideation Questionnaire-JR., Suicidal Behavior Inventory, and Reynolds Adolescent Depression Scale. Parents completed the Family Informant Schedule and Criteria, Children's Affective Liability Scale, AAII, and a partial DISC. Behavioral disinhibition (BD) measures were used to assign adolescents to MDD+BD (n = 41) and MDD-BD (n = 30) groups.

RESULTS

The MDD+BD group had a higher prevalence of drug use disorders in biological fathers than the MDD-BD group. The MDD+BD group also had higher proportions of paternal second degree relatives with alcohol use disorders, drug use disorders, and psychiatric hospitalizations, and a higher proportion of maternal second degree relatives with antisocial personality disorder.

LIMITATIONS

Limitations include reliance on single informants for family psychiatric histories and the failure to distinguish between child- and adolescent-onset depression.

CONCLUSIONS

Family psychiatric histories differentiated MDD adolescents grouped by the presence or absence of behavioral disinhibition, suggesting possible etiologic mechanisms. Further research on subtypes or comorbid presentations may assist in the development of targeted treatment strategies.

Childhood temperament and family environment as predictors of internalizing and externalizing trajectories from ages 5 to 17

Childhood temperament and family environment have been shown to predict internalizing and externalizing behavior; however, less is known about how temperament and family environment interact to predict changes in problem behavior. We conducted latent growth curve modeling on a sample assessed at ages 5, 7, 10, 14, and 17 (N = 337). Externalizing behavior decreased over time for both sexes, and internalizing behavior increased over time for girls only. Two childhood variables (fear/shyness and maternal depression) predicted boys' and girls' age-17 internalizing behavior, harsh discipline uniquely predicted boys' age-17 internalizing behavior, and maternal depression and lower family income uniquely predicted increases in girls' internalizing behavior. For externalizing behavior, an array of temperament, family environment, and Temperament x Family Environment variables predicted age-17 behavior for both sexes. Sex differences were present in the prediction of externalizing slopes, with maternal depression predicting increases in boys' externalizing behavior only when impulsivity was low, and harsh discipline predicting increases in girls' externalizing behavior only when impulsivity was high or when fear/shyness was low.

A risk and protective factors framework for understanding youth's externalizing problem behavior in two different cultural settings

OBJECTIVE

The main goal of the study was to analyze youth's externalizing problem behaviors based on a risk and protective factors framework in two different cultural settings.

METHOD

Data were collected among secondary school students in Szeged, Hungary (N=1240) and in Birmingham, AL, USA (N=1538). The self-administered questionnaires contained items on youth's externalizing problem behaviors as well as risk and protective factors.

RESULTS

In both samples, first year students in secondary (high) schools and boys reported greater levels of problem behaviors. Multiple regression analyses revealed that substance use, gang membership and low academic achievement were consistent risk factors and associated with higher reporting levels of problem behaviors in both cultures. Parental monitoring served as an important protective factor in both samples, while school protective factors were only significant for American students.

CONCLUSION

Findings draw attention to similar structures of certain risk and protective factors of youth's externalizing problem behaviors in different cultural settings. While there are universal risk factors (e. g., substance use, gang membership and low academic achievement), parental monitoring seems to be a universal protective factor against youth's externalizing problem behavior. An important difference is that the school domain seems to act as more important protection for American youth.

Hostility, depressive symptoms, and smoking in early adolescence

Using logistic and multiple regression, we examined the association between hostility, level of depressive symptoms, and smoking in a sample of 1699 ethnically diverse students in California. Self-reports were collected twice from each student, at the beginning of the 6th and 7th grade years. Among 6th graders who had not smoked, depressive symptoms and hostility were associated with smoking initiation by the 7th grade. Among those students who had already tried smoking, increases in depressive symptoms and hostility were associated with more frequent smoking. The association between hostility and smoking was stronger for students reporting higher levels of depressive symptoms.

Ten-year review of rating scales. VI: scales assessing externalizing behaviors

OBJECTIVE

This is the sixth article in a series of 10-year reviews of rating scales. The current article reviews scales that assess externalizing behaviors such as disruptive behavior disorders and aggression.

METHOD

Relevant scales were found by searching popular electronic databases. The search was then broadened by a review of the references in selected articles. Due to the paucity of well-established scales, any such scales with potential utility for elucidating the functioning of youths with externalizing behaviors were selected.

RESULTS

None of these scales is diagnosis-based, although some correlate with DSM-IV-defined disruptive behavior disorders. Most scales assessing disruptive behavior disorders have a solid normative base, good psychometric functioning, and high clinical utility. Scales assessing aggression comprise a bimodal group. Several have been adapted from the adult literature and are widely used in clinical practice, while others address theoretical aspects of aggression and are used predominantly in research. Empirical support for all of the scales assessing aggression varies widely, although several show potential for routine clinical practice.

CONCLUSIONS

Overall, these scales measure a variety of constructs with considerable utility for assessing youths' externalizing behaviors, predicting outcome, and evaluating treatment effects. Many need further validation with youth.