Preadolescent conduct problems in girls and boys

Fearlessness as an Underlying Mechanism Leading to Conduct Problems: Testing the INTERFEAR Model in a Community Sample in Spain

Conduct problems (CP) in childhood and adolescence have a significant impact on the individual, family, and community. To improve treatment for CP, there is a need to improve the understanding of the developmental pathways leading to CP in boys and girls. Prior research has linked the child's fearlessness and callous-unemotional (CU) traits, as well as experiences of parental warmth and punitive parenting, to CP. However, few studies have tested the interplay of these factors in contributing to future CP development. The present study aimed to test the InterFear model, which suggests that fearlessness in early childhood leads to CP through an indirect pathway involving low positive parenting, high negative/punitive parenting, and callous-unemotional (CU) traits. The sample included 2467 Spanish children (48.1% girls; Mage = 4.25; SD = 0.91), followed up across a five-year period. Besides a direct association between fearlessness in early childhood and future CP, the results found an indirect pathway whereby fearlessness reduces positive parenting and increases punitive parenting, which contributes to the development of CU traits and sets the stage for CP in later childhood. The specific indirect effect from fearlessness to CP via CU traits accounted for most of the variance, suggesting the existence of a temperamental pathway independent of parental variables. Further, two additional indirect pathways, exclusive of fearlessness, were identified, which started with low parental warmth and positive parenting, leading to CP via CU traits. These findings support the InterFear model, demonstrating multiple pathways to CP with the involvement of fearlessness, parenting practices, and CU traits. This model might play a pivotal role in the development of targeted prevention and intervention strategies for CP.

The Importance of Assessing Impairment Associated With Limited Prosocial Emotions

Limited prosocial emotions (LPE) are characterized by a lack of remorse or guilt, callousness/lack of empathy, being unconcerned about performance, and shallow/deficient affect. While previous research has largely focused on the presence or absence of LPE in youth, there is considerable evidence that symptom presence/absence and symptom impairment are separable dimensions, where impairment often is found to play a significant, unique role in assessing child psychopathology. The current study utilized a newly developed questionnaire with the purpose of exploring its psychometric properties and better understand the dual and potentially differential role LPE symptom presence and LPE-related impairment have in youth. Mothers (n = 265) of children (M_age = 8.04, SD = 2.07) completed questionnaires assessing LPE impairment, LPE symptoms, externalizing disorder symptoms, and functional impairment. Results demonstrated strong support for the psychometric properties of the newly developed measure of LPE impairment. Importantly, LPE-related impairment uniquely predicted all impairment domains above-and-beyond the effects of LPE symptoms, oppositional defiant disorder, and CD symptoms (as well as child age and sex covariates). Moreover, youth in the top 25th percentile on both LPE symptoms and LPE-related impairment (compared to youth only in the top 25th percentile in LPE symptoms) had greater mean externalizing symptoms and functional impairment. The preliminary evidence provided suggests researchers and clinicians may benefit from assessing both LPE symptoms and LPE-related impairment when attempting to identify youth with high levels of conduct problem symptoms and/or psychosocial impairment. Future research should aim to replicate and expand our findings to other clinical populations.

Clinical Characteristics of Personality and Conduct Disorders in Child Patients With Vasovagal Syncope: A Clinical Case-Control Study

Objective: To analyze the clinical characteristics of abnormal personality and conduct disorders (CDs) in pediatric patients with vasovagal syncope (VVS). Methods: In this study, we recruited patients diagnosed with VVS at Children's Heart Center from January 2018 to December 2020. Healthy children were recruited as controls. The Eysenck Personality Questionnaire-Child edition (EPQ-C) and Achenbach Child Behavior Checklist (CBCL) were used for the assessment. Results: One hundred and fifty-one VVS patients and 151 healthy controls were included in this study. Compared with the control group, patients in the VVS group had a higher incidence of abnormal personality and were more prone to suffer from CDs. Moreover, pediatric patients with VVS suffered more events of syncope recurrence if they had CDs. Conclusion: Abnormal personality and CDs are common clinical characteristics in pediatric patients with VVS.

Gender-Specific Trajectories of Conduct Problems from Ages 3 to 11

Gender-specific pathways of conduct problems (CP) from toddlerhood have received little attention. Using a nationally representative sample of UK children born in 2000–2001 (6458 boys and 6340 girls), the current study (a) identified subgroups of CP pathways separately for boys and girls from ages 3 to 11 and (b) examined early precursors (pregnancy to 9 months) of these trajectories. Group-based trajectory models identified four distinct trajectories for both boys and girls: each characterized as ‘low’; ‘early-onset, desisting’; ‘early-onset, persistent’ and ‘school-onset’. This suggests that the taxonomic framework developed to conceptualise childhood-onset CP among males is also applicable to females, though needing some revision to capture heterogeneity identified during early and middle childhood. We also found significant precursors of the different trajectory groups with some variation by gender. Early socioeconomic deprivation was a significant risk factor of the early-onset pathways among both genders, but played no significant role for ‘school-onset’. Childhood-onset trajectories of boys, but not girls, were predicted by parenting attitudes and behaviour.

Mortality in individuals with disruptive behavior disorders diagnosed by specialist services - A nationwide cohort study

Disruptive behavior disorders (DBDs), inclusive of oppositional defiant disorder (ODD) and conduct disorder (CD), are associated with outcomes likely to increase risk of mortality. Using Danish National Registers, a total of 1.92 million individuals including 9495 individuals with DBDs diagnosed by specialist services were followed from their first birthday to 2013. Those with and without DBDs were compared using mortality rate ratios (MRRs) estimated using Poisson regression and adjusted for calendar period, age, sex, family history of psychiatric disorders, maternal age at time of birth, paternal age at time of birth, parental education status, and parental employment status. Over the course of follow up, which totalled 24.9 million person-years, 5580 cohort members died including 78 individuals with DBDs. The mortality rate per 10,000 person-years was 9.66 for individuals with DBDs compared to 2.22 for those with no diagnosis. This corresponded to a fully adjusted MRR of 2.57 (95% confidence interval 2.04-3.20). Comorbid substance use disorder and attention-deficit/hyperactivity disorder resulted in the highest MRR across all categories. These findings demonstrate the excess mortality associated with DBDs.

Long-Term Outcomes of Attention-Deficit/Hyperactivity Disorder and Conduct Disorder: A Systematic Review and Meta-Analysis

OBJECTIVE

Attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) are common externalizing disorders. Despite previous research demonstrating that both are longitudinally associated with adverse outcomes, there have been no systematic reviews examining all of the available evidence linking ADHD and CD with a range of health and psychosocial outcomes.

METHOD

Electronic databases (EMBASE, Medline, and PsycINFO) were searched for studies published from 1980 up to March 2015. Published cohort and case-control studies were included if they reported a longitudinal association between ADHD or CD and adverse outcomes with a minimum follow-up of 2 years. Outcomes with sufficient data were pooled in a random effects meta-analysis to give overall odds ratios (ORs) with corresponding 95% CIs.

RESULTS

Of the 278 studies assessed, 114 met inclusion criteria and 98 were used in subsequent meta-analyses. ADHD was associated with adverse outcomes including academic achievement (e.g. failure to complete high school; odds ratio [OR] = 3.7, 95% CIs 2.0-7.0), other mental and substance use disorders (e.g. depression; OR = 2.3, 1.5-3.7), criminality (e.g. arrest; OR = 2.4, 1.5-3.8), and employment (e.g., unemployment; OR = 2.0, 1.0-3.9). CD was associated with outcomes relating to academic achievement (e.g. failure to complete high school; OR = 2.7, 1.5-4.7), other mental and substance use disorders (e.g., illicit drug use; OR = 2.1, 1.7-2.6), and criminality (e.g. violence; OR = 3.5, 2.3-5.3).

CONCLUSION

This study demonstrated that ADHD and CD are associated with disability beyond immediate health loss. Although the analyses could not determine the mechanisms behind these longitudinal associations, they demonstrate the importance of addressing ADHD and CD early in life so as to potentially avert a wide range of future adverse outcomes.

Longitudinal associations between conduct problems and depressive symptoms among girls and boys with early conduct problems

Youth with conduct problems (CP) may experience high rates of depressive symptoms (DS). However, little is known about the direction of the longitudinal associations between CP and DS in this specific population. Although girls with CP appear at greater risk than boys for presenting comorbid depression, empirical research on gender differences in these associations is even sparser. The current study used autoregressive latent trajectory models to compare four perspectives with hypotheses regarding the longitudinal associations between CP and DS, while taking into account the evolution of both problems. We also examined gender differences in the longitudinal associations. A total of 345 children (40.6 % female) presenting with a high level of CP in early elementary school (mean age at study inception = 8.52; SD = .94) were evaluated annually over a four-year period (5 measurement time points). The results revealed that CP and DS were quite stable over time. Moreover, CP and DS showed strong covariation at each measurement time point, but only one significant positive cross-lagged association between the two processes, indicating that higher levels of DS at time 3 were associated with higher levels of CP 1 year later. No differences were observed in the longitudinal associations between CP and DS in boys and girls. Given the comorbidity and stability of CP and DS, these findings suggest that DS should be systematically evaluated among children with early clinically significant CP, and treatment plans should include interventions aimed at both CP and DS among children who present with both types of problems.

The Eyberg Child Behavior Inventory: Factorial invariance in problem behaviors across gender and age

The Eyberg Child Behavior Inventory (ECBI) assesses problem behaviors in children, and is a widely used instrument in both clinical work and research. Evidence suggests that the short ECBI version, comprising 22 items, can be reduced into the three oblique factors: Oppositional defiant behavior; Conduct problem behavior; and Inattentive behavior. The present study aimed to evaluate this three-factor model in a Norwegian sample of 554 children, and examine multi-group invariance across gender and age. Consistent with previous research, results confirmed a tripartite model, with the same residual covariances and cross-loading appearing across groups. Multi-group confirmatory factor analysis demonstrated partial measurement invariance across gender and age. Overall, findings support a meaningful comparison of the short ECBI across gender and age. The study makes a contribution to the generalizability issue of the ECBI.

Disabling chronic conditions in childhood and socioeconomic disadvantage: a systematic review and meta-analyses of observational studies

OBJECTIVE

To determine the association of socioeconomic disadvantage with the prevalence of childhood disabling chronic conditions in high-income countries.

STUDY DESIGN

Systematic review and meta-analyses.

DATA SOURCES

6 electronic databases, relevant websites, reference lists and experts in the field.

STUDY SELECTION

160 observational studies conducted in high-income countries with data on socioeconomic status and disabling chronic conditions in childhood, published between 1 January 1991 and 31 December 2013.

DATA EXTRACTION AND SYNTHESIS

Abstracts were reviewed, full papers obtained, and papers identified for inclusion by 2 independent reviewers. Inclusion decisions were checked by a third reviewer. Where reported, ORs were extracted for low versus high socioeconomic status. For studies reporting raw data but not ORs, ORs were calculated. Narrative analysis was undertaken for studies without data suitable for meta-analysis.

RESULTS

126 studies had data suitable for meta-analysis. ORs for risk estimates were: all-cause disabling chronic conditions 1.72 (95% CI 1.48 to 2.01); psychological disorders 1.88 (95% CI 1.68 to 2.10); intellectual disability 2.41 (95% CI 2.03 to 2.86); activity-limiting asthma 2.20 (95% CI 1.87 to 2.85); cerebral palsy 1.42 (95% CI 1.26 to 1.61); congenital abnormalities 1.41 (95% CI 1.24 to 1.61); epilepsy 1.38 (95% CI 1.20 to 1.59); sensory impairment 1.70 (95% CI 1.39 to 2.07). Heterogeneity was high across most estimates (I(2)>75%). Of the 34 studies without data suitable for meta-analysis, 26 reported results consistent with increased risk associated with low socioeconomic status.

CONCLUSIONS

The findings indicate that, in high-income countries, childhood disabling chronic conditions are associated with social disadvantage. Although evidence of an association is consistent across different countries, the review provides limited evidence to explain the association; future research, using longitudinal data, will be required to distinguish low socioeconomic status as the cause or consequence of childhood disabling chronic conditions and the aetiological pathways and mechanisms.

A Swedish national twin study of criminal behavior and its violent, white-collar and property subtypes

BACKGROUND

We sought to clarify the etiological contribution of genetic and environmental factors to total criminal behavior (CB) measured as criminal convictions in men and women, and to violent (VCB), white-collar (WCCB) and property criminal behavior (PCB) in men only.

METHOD

In 21 603 twin pairs from the Swedish Twin Registry, we obtained information on all criminal convictions from 1973 to 2011 from the Swedish Crime Register. Twin modeling was performed using the OpenMx package.

RESULTS

For all criminal convictions, heritability was estimated at around 45% in both sexes, with the shared environment accounting for 18% of the variance in liability in females and 27% in males. The correlation of these risk factors across sexes was estimated at +0.63. In men, the magnitudes of genetic and environmental influence were similar in the three criminal conviction subtypes. However, for violent and white-collar convictions, nearly half and one-third of the genetic effects were respectively unique to that criminal subtype. About half of the familial environmental effects were unique to property convictions.

CONCLUSIONS

The familial aggregation of officially recorded CB is substantial and results from both genetic and familial environmental factors. These factors are moderately correlated across the sexes suggesting that some genetic and environmental influences on criminal convictions are unique to men and to women. Violent criminal behavior and property crime are substantially influenced respectively by genetic and shared environmental risk factors unique to that criminal subtype.

The School Children Mental Health in Europe (SCMHE) Project: Design and First Results

Background : The School Children Mental Health in Europe (SCMHE) project aims to build up a set of indicators to collect and monitor children's mental health in an efficient and comparable methodology across the EU countries. It concerns primary schools children aged 6 to 11 years a range where few data are available whereas school interventions are promising. Methods : Three informants were used: parents, teachers and children. In selecting instruments language, instruments were selected according to the easiness to translate them: SDQ (Strengths and Difficulties Questionnaire) for parents and teachers and DI (Dominic Interactive). A two-step procedure was used: schools randomization then six children by class in each grade. Results : 9084 children from seven countries (Italy, Netherlands, Germany, Romania, Bulgaria, Lithuania, and Turkey) completed the Dominic Interactive in their own language. 6563 teachers and 6031 parents completed their questionnaire, and a total of 5574 interviews have been completed by the 3 informants. The participation rate of the children with parents in the participating schools was about 66.4%. As expected teachers report more externalised problems and less internalised problems than parents. Children report more internalised problems than parents and teachers. Boys have consistently more externalised problems than girls and this is the reverse for internalised problems. Combining the diverse informants and impairment levels children with problems requiring some sort of mental health care were about 9.9%: 76% did not see any mental health professional: 78.7% In Eastern countries 63.1% in Western Europe.

The value of measuring impact alongside symptoms in children and adolescents: a longitudinal assessment in a community sample

The impact that psychiatric symptoms have on the lives of young people is central to clinical practice and classification. However, there is relatively little research on impact and its association with symptoms. This paper examines how well impact can be measured and how it relates to psychiatric outcomes. On four separate occasions over 3 years, symptoms and impact were assessed in a UK epidemiological sample (n = 4,479; 51.5 % boys) using the Strengths and Difficulties Questionnaire (SDQ) as reported by parents, youths and teachers. Disorders were ascertained using the Development and Well-Being Assessment. An impact scale made of items about distress and impairment demonstrated considerable internal consistency, cross-informant correlations, and longitudinal stability by all reporting sources. Impact at baseline was a strong predictor of psychiatric disorder 3 years later after accounting for psychiatric disorders and symptoms measured at baseline: odds ratio OR = 2.10, 95 % Confidence Interval (CI) [1.50, 2.94] according to parent-rated impact and OR = 1.71, CI [1.08, 2.72] according to teacher-rated impact. Changes in impact over time were predicted, but not fully accounted for, by symptoms measured at baseline. Impact can be reliably and easily measured across time, and it may be clinically useful as an independent predictor of future symptoms and psychiatric disorders. More studies are needed to understand inter-individual variation in the impact caused by equivalent symptoms.

Current issues in the diagnosis of attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder

This review evaluates the diagnostic criteria for three of the most common disorders for which children and adolescents are referred for mental health treatment: attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD). Although research supports the validity and clinical utility of these disorders, several issues are highlighted that could enhance the current diagnostic criteria. For ADHD, defining the core features of the disorder and its fit with other disorders, enhancing the validity of the criteria through the lifespan, considering alternative ways to form subtypes of the disorder, and modifying the age-of-onset criterion are discussed relative to the current diagnostic criteria. For ODD, eliminating the exclusionary criteria of CD, recognizing important symptom domains within the disorder, and using the cross-situational pervasiveness of the disorder as an index of severity are highlighted as important issues for improving classification. Finally, for CD, enhancing the current subtypes related to age of onset and integrating callous-unemotional traits into the diagnostic criteria are identified as key issues for improving classification.

Oppositional defiant disorder-gender differences in co-occurring symptoms of mental health problems in a general population of children

Informant- and gender-specific characteristics of Oppositional Defiant Disorder (ODD) and how these might relate to patterns of comorbidity need to be further clarified. We collected data from 7,007 children (aged 7-9) who participated in the Bergen Child Study (BCS), an ongoing population-based study of children's development and mental health. A questionnaire containing the DSM-IV behavioral descriptions of ODD was distributed to parents and teachers. Co-occurring symptoms of mental health problems were measured by the Strengths and Difficulties Questionnaire (SDQ). The boys (n = 122) and girls (n = 41) with symptomatic ODD had an increased risk of co-occurring emotional symptoms, hyperactivity or inattention and peer problems, as compared to their peers without symptomatic ODD. The impact of symptomatic ODD was higher for boys than girls in teacher reported SDQ ratings, except for emotional symptoms. There were no significant interaction effects of gender in parent SDQ ratings. Our results are contrary to the gender paradox hypothesis, which states that co-occurring symptoms of mental health problems are more frequent among girls with ODD as compared to boys with ODD.

Predictive validity of DSM-IV oppositional defiant and conduct disorders in clinically referred preschoolers

BACKGROUND

Diagnostic validity of oppositional defiant and conduct disorders (ODD and CD) for preschoolers has been questioned based on concerns regarding the ability to differentiate normative, transient disruptive behavior from clinical symptoms. Data on concurrent validity have accumulated, but predictive validity is limited. Predictive validity is critical to refuting the hypothesis that diagnosing ODD and CD in young children leads to pathologizing normal behavior. ODD and CD have emerged as gateway disorders to many forms of adult psychopathology. Establishing how early we can identify symptoms and disorders that herald poor prognosis is one of the most important goals for research on etiology and prevention.

METHODS

Subjects were 3-5-year-old consecutive referrals to a child psychiatry clinic (n=123) and demographically matched children from a pediatric clinic (n=100). A diagnostic interview was used to assess DSM-IV ODD and CD in a prospective follow-up design from preschool to school age. Stability of ODD and CD diagnoses and level of impairment were tested as a function of preschool diagnosis.

RESULTS

Over 80% of preschoolers diagnosed with ODD and approximately 60% of preschoolers diagnosed with CD met criteria for the same disorder during follow-up. Impairment over time varied significantly as a function of stability of diagnosis across three years.

CONCLUSIONS

These results provide the first evidence of the predictive validity of DSM-IV ODD and CD in clinically referred preschool children. The findings challenge the assumption that symptoms of disruptive behavior disorders that occur during the preschool period tend to be transient.

Delivering Child Community Psychology Services in the Community: Experiences from the NIPPERS Project

BACKGROUND

  The NIPPERS (Nursery Intervention Project for Parents & Education Related Services) was a novel community psychology service based in nursery settings in socio-economically disadvantaged, inner-city areas in London.

METHOD

  The service included consultation work with nursery staff, structured parenting groups and individual sessions for parents.

RESULTS

  The delivery of the clinical service and research evaluation underwent several changes in the first phase of the project, in particular to ensure that the service was acceptable and accessible to families and staff. Although take-up of community services was higher than in the local clinic-based services, it was not taken up by some 40% of parents. Due to the allocation design, it was not possible to measure the effectiveness of the intervention.

CONCLUSIONS

  The NIPPERS service was successful in delivering a community child psychology service to families with high levels of early child behavioural problems at high risk for continuing difficulties.

Prevalence of DSM-IV disorder in a representative, healthy birth cohort at school entry: sociodemographic risks and social adaptation

OBJECTIVE

The aims of this paper are as follows: to present past-year prevalence data for DSM-IV disorders in the early elementary school years; to examine the impact of impairment criteria on prevalence estimates; to examine the relation of sociodemographic and psychosocial risk factors to disorders; and to explore associations between "internalizing" and "externalizing" disorders and social competence and family burden as further validation of the impairing nature of these disorders.

METHOD

As part of a longitudinal representative population study of children born healthy between July 1995 and September 1997 in the New Haven-Meriden Standard Metropolitan Statistical Area of the 1990 Census (n = 1,329), parents of a subsample enriched for child psychopathology (n = 442; 77.6% response rate, 69.5% of eligible sample) were interviewed in the child's kindergarten or first-grade year with the Diagnostic Interview Schedule for Children, Version IV (DISC-IV). Parents were surveyed about sociodemographic and psychosocial characteristics, and both parents and teachers were surveyed about social competence.

RESULTS

Approximately one in five (21.6 %) children met criteria for psychiatric disorder(s) with impairment. Sociodemographic and psychosocial correlates included persistent poverty beginning in early childhood, limited parental education, low family expressiveness, stressful life events, and violence exposure. Finally, diagnostic status was significantly associated with poorer social competence and family burden.

CONCLUSIONS

That approximately one in five children evidenced a psychiatric disorder with impairment during the transition to formal schooling highlights the importance of integrating psychiatric epidemiological and developmental approaches to inform conversations about school readiness and intervention planning.

Sex Differences in Trajectories of Offending Among Puerto Rican Youth

Although sex is one of the strongest correlates of crime, contentions remain regarding the necessity of sex-specific theories of crime. The current study examines delinquent trajectories across sex among Puerto Rican youth socialized in two different cultural contexts (Bronx, United States and San Juan, Puerto Rico). Results indicate: similar substantive offending trajectories across males and females within each cultural context; that males exhibit a higher frequency of offending and higher levels of risk factors for delinquency; and there more similarities than differences in how risk/protective factors relate to patterns of offending across male versus female youth. Study limitations and implications for sex-specific criminological theories are also discussed.

Predictors and sequelae of trajectories of physical aggression in school-age boys and girls

Teacher-rated trajectories of physical aggression in boys and girls from first through sixth grade were examined using data from the NICHD Study of Early Child Care and Youth Development. In separate analyses, four trajectories were identified in boys and three in girls. Higher levels of aggression in both boys and girls were related to greater sociodemographic risk and higher maternal harshness in the preschool years; lower levels of observed maternal sensitivity during early childhood also predicted higher trajectories of aggression among girls. Trajectory groups also differed on a range of social and academic adjustment outcomes in sixth grade, with the most aggressive children and even moderately aggressive children evidencing some difficulties in adjustment. Patterns and levels of aggression in boys and girls are discussed as are their predictors and consequences.

Should there be separate parent and teacher-based categories of ODD? Evidence from a general population

OBJECTIVE

To examine the occurrence of oppositional defiant disorder (ODD) symptoms in a general population of boys and girls, as reported by parents and teachers, and to investigate differences in prevalence estimates, depending on how parents' and teachers' ratings were combined.

METHOD

Data were collected from 7007 children (aged 7-9) who participated in The Bergen Child Study (BCS), an ongoing population-based study of children's development and mental health. ODD symptoms were measured by the SNAP-IV (Swanson, Nolan, & Pelham-IV) Oppositional Defiant Disorder sub-scale (SNAP-IV ODD) that was distributed to parents and teachers. Co-occurring symptoms of mental health problems were measured by the Strengths and Difficulties Questionnaire (SDQ).

RESULTS AND CONCLUSION

Prevalence-estimates of ODD varied considerably depending on how ratings from parents and teachers were combined. Specific ODD symptoms occurred at very different rates depending on the rater and on the gender of the child being rated. Parents and teachers co-identified very few children with ODD. ODD identified by only one informant was associated with high levels of comorbid mental health problems and impairment according to both informants. The results support an informant-specific conceptualization of childhood ODD.

The role of harsh discipline in explaining sex differences in conduct disorder: a study of opposite-sex twin pairs

In the current study, two hypotheses about the role of harsh discipline (HD) in explaining the sex difference in the prevalence of conduct disorder (CD) were evaluated: that boys exhibit more CD than girls because (1) they are exposed to more HD and/or (2) there is a greater association between HD and CD in boys. These hypotheses were evaluated in a sample of male and female adult twins from different families (N = 3,502) as well as a sample of adult twin brothers and sisters (N = 655) in order to examine the extent to which sex differences remained after controlling for between-family differences. Retrospective reports of HD experienced between ages 6-13 and DSM-IV CD symptoms experienced before age 18 were obtained via structured psychiatric telephone interviews. Boys reported higher mean levels of HD and CD than girls, both between and within families, and the results of model-fitting analyses suggested that differences in the use of harsh disciplinary practices for sons versus daughters may partially explain the sex difference in the prevalence of CD. Between families, the relation between HD and CD was greater for girls than boys, but within families, there was no evidence of a sex difference in the relation between HD and CD. Inconsistent between-family and within-family results suggest that factors that differ between families are confounded with sex differences in the relation between HD and CD. A more stringent test of sex differences involves eliminating these between-family differences by studying boys and girls within the same family.

Behaviour problems in young children in rural Bangladesh

OBJECTIVE

To determine the prevalence of child behaviour problems reported by parents in rural Bangladesh.

METHODS

A total of 4,003 children aged 2-9 years were identified during a population-based survey of 2,231 households. A predetermined sample of 499 was selected, of which health professionals saw 453 (90.8%) for structured physical and neurological examination, standardized testing of cognition and adaptive behaviour and parent report of developmental history and behaviour problems.

RESULTS

The prevalence of behaviour impairments was 14.6% (95% CI 11.4, 17.9). The majority involved somatic complaints, including nocturnal enuresis and pica. Problems such as aggression or restlessness were infrequently reported. Behaviour impairments were significantly associated with malnutrition (prevalence ratio 2.1, 95% CI 1.2, 3.6, p < 0.01) and cognitive, motor or seizure disabilities (prevalence ratio 1.8, 95% CI 1.1, 2.9, p < 0.05).

CONCLUSIONS

The prevalence and nature of reported behaviour impairments in rural Bangladesh have implications for public health planning and delivery of health services.

Longitudinal outcome of youth oppositionality: irritable, headstrong, and hurtful behaviors have distinctive predictions

OBJECTIVE

Oppositional behavior in youths is one of the strongest predictors of a wide range of psychiatric disorders. We test the hypothesis that oppositionality encompasses an Irritable, a Headstrong, and a Hurtful dimension, each with distinct predictions.

METHOD

Longitudinal design combining data from two British national surveys and their respective 3-year follow-ups (N = 7,912). The Developmental and Well-Being Assessment was used to generate DSM-IV diagnoses.

RESULTS

The Irritable dimension was the sole predictor of emotional disorders at follow-up and was particularly associated with distress disorders (depression and anxiety) rather than fear disorders (phobias, separation anxiety, and panic disorder), both before and after adjustment for baseline psychopathology. The Headstrong dimension was the only predictor of attention-deficit/hyperactivity disorder at follow-up. Both Headstrong and Hurtful predicted conduct disorder, although only the Headstrong dimension did so after adjustment for baseline psychopathology. The Hurtful dimension was the strongest predictor of aggressive conduct disorder symptoms.

CONCLUSIONS

Our data suggest a developmental model of mental disorder whereby oppositionality is an interim shared manifestation of different dimensions of psychopathology with distinct outcomes.

Three dimensions of oppositionality in youth

BACKGROUND

Oppositional defiant disorder (ODD) in youth is a strong predictor of mental illness yet the wide range of associations with psychiatric disorders remains largely unexplained. The aim of this study was to investigate whether the identification of irritable, headstrong and hurtful dimensions within youth oppositionality would clarify the pattern of associations between oppositionality and a wide range of psychopathology in early and adult life.

METHODS

Cross-sectional data from national mental health surveys including 18,415 subjects aged 5-16 in the United Kingdom. The main outcome measures were the associations between a priori hypothesised dimensions of oppositionality with psychiatric disorders and symptoms; parent and teacher-derived information were used in multivariate regression analysis.

RESULTS

Our three a priori dimensions had very different associations with disorders and symptom scales. Irritability was the only predictor of emotional disorders (parent report: OR = 3.26 [CI 95% 2.79, 3.80]; teacher report: OR = 2.78 [2.39, 3.22]); the hurtful dimension was particularly strongly associated with seeming cold-blooded or callous (parent report: beta = .32 [.27, .37]; teacher report: .33 [.30, .36]); and the headstrong dimension was most strongly associated with attention deficit hyperactivity disorder (ADHD; parent report: OR = 3.21 [2.43, 4.23]; teacher report : OR = 7.18 [5.25, 9.82]). All three dimensions were associated with conduct disorder, with the headstrong dimension being the main predictor of non-aggressive symptoms (parent report: beta = .31 [.27, .34]; teacher report: .43 [.40, .45]), and with the hurtful dimension being the main predictor of aggressive symptoms (parent report: beta = .35 [.32, .39]; teacher report: .40 [.39, .42]).

CONCLUSIONS

The three dimensions of oppositionality have distinctive external correlates, suggesting they may also be differential predictors of aetiology, prognosis and treatment responsiveness.

Pervasive behavior problems at 6 years of age in a total-population sample of children born at </= 25 weeks of gestation

OBJECTIVE

The goal was to test whether extremely preterm children have more pervasive behavior problems than classroom peers, by using parent and teacher consensus reports. Is there an excess number of extremely preterm boys with behavior problems?

METHODS

A total-population study of all extremely preterm children in the United Kingdom and Ireland was performed. All children born at </=25 weeks of gestation in the United Kingdom and Ireland between March and December 1995 were assessed at 76 months of age (range: 62-87 months) (EPICure study). Pervasive behavior problems were defined as scoring >90th percentile on parent and teacher reports with a standard behavior scale, the Strengths and Difficulties Questionnaire. Of the 241 of 308 survivors who responded (78% of survivors), 200 had full reports on behavior problems from teachers and parents; they were compared with 148 control children.

RESULTS

A total of 19.4% of extremely preterm children (boys: 23.2%; girls: 15.6%), compared with 3.4% of control children (boys: 4.6%; girls: 2.5%) had total behavior scores in the clinical range. Hyperactivity (extremely preterm: 30.6%; control: 8.8%) and conduct problems (extremely preterm: 12.5%; control: 5.4%) could be accounted for by cognitive deficits, but attention (extremely preterm: 33.3%; control: 6.8%), peer (extremely preterm: 25.4%; control: 5.4%), and emotional (extremely preterm: 13.5%; control: 4.1%) problems were not explained by poor cognitive functioning. Extremely preterm boys had behavior problems in excess of gender differences found in the control group in hyperactivity, attention, and prosocial problems, and the impact on parents and teachers was greater for extremely preterm boys than girls.

CONCLUSIONS

Pervasive behavior problems are more frequent in children born at the limits of viability than previously reported for larger preterm populations. Extremely preterm boys seem most vulnerable, and the impact on parents and teachers is considerable.

Female and male antisocial trajectories: from childhood origins to adult outcomes

This article reports on the childhood origins and adult outcomes of female versus male antisocial behavior trajectories in the Dunedin longitudinal study. Four antisocial behavior trajectory groups were identified among females and males using general growth mixture modeling and included life-course persistent (LCP), adolescent-onset, childhood-limited, and low trajectory groups. During childhood, both LCP females and males were characterized by social, familial and neurodevelopmental risk factors, whereas those on the adolescent-onset pathway were not. At age 32, women and men on the LCP pathway were engaging in serious violence and experiencing significant mental health, physical health, and economic problems. Females and males on the adolescent-onset pathway were also experiencing difficulties at age 32, although to a lesser extent. Although more males than females followed the LCP trajectory, findings support similarities across gender with respect to developmental trajectories of antisocial behavior and their associated childhood origins and adult consequences. Implications for theory, research, and practice are discussed.

Emotional symptoms in inattentive primary school children: a population-based study

OBJECTIVE

The present study investigates teacher and parent reports of inattention and emotional symptoms in 6,229 primary school children.

METHOD

The assessment included the Emotional Symptoms subscale and the Impact scale from the Strengths and Difficulties Questionnaire and the inattention items from the Swanson, Nolan, and Pelham IV Questionnaire.

RESULTS

Children defined as inattentive showed a high risk of being defined as high scorers on the Emotional Symptoms subscale. A high score on both the Inattention and Emotional Symptoms subscales was associated with a high impact score. Teachers but not parents reported a higher risk of such co-occurrence of symptoms in girls than in boys.

CONCLUSION

Inattentive children should be screened for emotional problems by use of the multi-informants method.

Family study of subthreshold psychopathology in a community sample

BACKGROUND

There has been increasing interest in the validity and familial transmission of subthreshold psychiatric conditions and the relationship between subthreshold conditions and full syndrome (FS) disorders. However, most of these studies examined a single subthreshold condition and thus fail to take into account the high co-morbidity among subthreshold conditions and between subthreshold conditions and FS disorders.

METHOD

A family study of subthreshold psychiatric conditions was conducted with 739 community-drawn young adults and their 1744 relatives. We examined (1) whether relatives of probands with subthreshold major depression, bipolar disorder, anxiety disorders, alcohol use, substance use, and/or conduct disorder exhibited an increased rate of the corresponding (homotypic) FS disorder; (2) whether subthreshold disorders were associated with increased familial rates of other (heterotypic) FS disorders; (3) whether subthreshold and FS conditions are associated with similar familial liabilities; and (4) whether these homotypic and heterotypic associations persisted after controlling for co-morbidity.

RESULTS

Significant homotypic associations were observed for subthreshold anxiety, alcohol, conduct, and a trend was observed for major depression. Only the homotypic association for alcohol and conduct remained after controlling for co-morbid subthreshold and FS conditions. Many heterotypic associations were observed and most remained after controlling for co-morbidity.

CONCLUSIONS

It is important to broaden the study of subthreshold psychopathology to multiple disorders. In particular cases, controlling for co-morbidity with other subthreshold and FS conditions altered the patterns of familial aggregation. Etiological processes that are common to particular disorders and subthreshold conditions are discussed.

Research review: DSM-V conduct disorder: research needs for an evidence base

This article charts a strategic research course toward an empirical foundation for the diagnosis of conduct disorder in the forthcoming DSM-V. Since the DSM-IV appeared in 1994, an impressive amount of new information about conduct disorder has emerged. As a result of this new knowledge, reasonable rationales have been put forward for adding to the conduct disorder diagnostic protocol: a childhood-limited subtype, family psychiatric history, callous-unemotional traits, female-specific criteria, preschool-specific criteria, early substance use, and biomarkers from genetics, neuroimaging, and physiology research. This article reviews the evidence for these and other potential changes to the conduct disorder diagnosis. We report that although there is a great deal of exciting research into each of the topics, very little of it provides the precise sort of evidence base required to justify any alteration to the DSM-V. We outline specific research questions and study designs needed to build the lacking evidence base for or against proposed changes to DSM-V conduct disorder.

The gradual emergence of sex differences in aggression: alternative hypotheses

Nearly a century of observational studies and more recent longitudinal surveys reveal that, in infancy, girls and boys use force at similar rates. Over the next few years boys become significantly more aggressive. Alternative hypotheses accounting for the widening gender gap are evaluated. These include hypotheses about normative patterns of male escalation and female desistance; boys' preference for active play that promotes aggression; girls' tendency to hide aggression; girls' use of alternative forms of aggression; boys' increased risk for the cognitive and emotional problems that are linked to aggression; boys' sensitivity to situational triggers of aggression; and boys' vulnerability to adverse rearing environments. The evidence bearing on each hypothesis is mixed. In general, the overall difference between the sexes appears to be produced by a minority of boys who deploy aggression at high rates. Three general principles govern the emergence of sex differences in aggression: female precocity, male vulnerability, and the salience of sex as a social category that shapes children's lives.