Kindergarten conduct problems are associated with monetized outcomes in adolescence and adulthood

Heterogeneity of early-onset conduct problems: assessing different profiles, predictors and outcomes across childhood

BACKGROUND

Among early-onset conduct problems (CP), associated with more disruptive behaviors of greater intensity and stability, several domains have been proposed from a variable-centered perspective to capture their heterogeneity: oppositional defiant disorder (ODD), attention-deficit/hyperactivity disorder (ADHD), and callous-unemotional traits (CU). Using a person-centered approach, the present study aims to identify distinct profiles of child CP, examining different predictors and developmental outcomes.

METHODS

Data included parent- and teacher-reported questionnaires from an ongoing longitudinal study (ELISA). Latent profiles were identified first in a community sample (n = 2,103; age 4-8 years; 50.9% boys) and replicated in a high-CP subsample (n = 168; 70.24% boys).

RESULTS

Four profiles emerged in the community sample (Normative Development, Daring/Impulsive, Low prosociality + Fear; Low prosociality + Psychopathic Traits [PP]), and three in the high-CP sample (same except the normative). The identified CP profiles aligned with the ADHD and CU domains, but not the ODD domain. Differences in activity, punitive and inconsistent parenting emerge as the most significant predictors. Regarding the outcomes, the Low prosociality + PP profile stands out as the group with the most severe emotional, social and behavioral maladjustment.

CONCLUSIONS

These findings highlight the heterogeneity within CP, and the importance of designing specific and tailored interventions for each identified profile.

Impaired sleep quality mediates the relationship between internet gaming disorder and conduct problems among adolescents: a three-wave longitudinal study

BACKGROUND

Research increasingly demonstrates a positive association between Internet Gaming Disorder (IGD) and conduct problems among adolescents. However, longitudinal data are limited, and the mediating mechanisms remain unclear. This study aimed to examine the predictive effect of IGD on conduct problems and explore the mediating role of impaired sleep quality.

METHOD

A cohort of 20,137 Chinese seventh- and tenth-grade students was recruited and assessed at three time points: November 2020 (T1), 2021 (T2), and 2022 (T3). IGD, conduct problems, and impaired sleep quality were measured using the Internet Gaming Disorder Scale Short Form, the Strengths and Difficulties Questionnaire, and the Pittsburgh Sleep Quality Index, respectively. Mediation analyses were conducted to evaluate the direct and indirect effect of IGD on conduct problems, with subgroup analyses based on sex and developmental stage.

RESULTS

IGD was found to be an independent risk factor for conduct problems both cross-sectionally and longitudinally. Impaired sleep quality partially mediated the relationship between IGD and conduct problems, accounting for approximately 17.3% of the total effect. Subgroup analyses revealed that the mediation effect of impaired sleep quality was more pronounced in early adolescents and varied by sex, with a stronger total and direct effect in boys.

CONCLUSIONS

These findings highlight the need for comprehensive interventions targeting both IGD and impaired sleep quality, tailored to specific sexes and developmental stages, to effectively reduce conduct problems.

Callous-unemotional traits, cognitive functioning, and externalizing problems in a propensity-matched sample from the ABCD study

BACKGROUND

Many studies show that both callous-unemotional (CU) traits (e.g., low empathy, lack of guilt) and cognitive difficulties increase risk for externalizing psychopathology across development. However, other work suggests that some aggression (e.g., relational, proactive) may rely on intact cognitive function, which could vary based on the presence of CU traits. Moreover, no prior research has adequately accounted for common risk factors shared by CU traits, cognitive difficulties, and externalizing problems, which confounds conclusions that can be drawn about their purported relationships. The current study addressed these knowledge gaps by leveraging rigorous propensity matching methods to isolate associations between CU traits and different dimensions of cognitive function and externalizing problems.

METHODS

Associations between CU traits, cognitive functioning, and externalizing outcomes were tested within dimensional (n = 11,868) and propensity-matched group-based (n = 1,224) models using data from the Adolescent Brain Cognitive Development Study®, with rigorous statistical control for shared sociodemographic risk factors. Cross-sectional outcomes were parent-reported symptoms of conduct disorder (CD), oppositional defiant disorder (ODD), and attention deficit hyperactivity disorder (ADHD). Longitudinal outcomes were child-reported overt and relational aggression.

RESULTS

CU traits were uniquely related to more parent-reported CD, ODD, ADHD symptoms, as well as more child-reported aggressive behaviors. Effects of cognitive difficulties were domain specific and were not consistent across dimensional and propensity matched models. There was minimal evidence for divergent associations between CU traits and externalizing outcomes as a function of cognition (i.e., no moderation).

CONCLUSIONS

Rigorous control for sociodemographic factors within propensity-matched models establish CU traits as a robust and unique risk factor for externalizing psychopathology, over and above difficulties with cognitive functioning.

Future Directions for Conduct Disorder and Psychopathic Trait Specifiers

Conduct disorder (CD) is a psychiatric diagnosis characterized by a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate social norms or rules are violated. This article presents information on CD with an emphasis on a new multispecifier personality model that could offer a valuable new perspective on CD by refining the way we specify CD. The multispecifier model may have the potential to clarify the considerable confusion that has occurred over past decades and improve our understanding of prevalence, etiology, course, and treatment of youth with conduct problems. In this paper, we present a new structure for CD designed to inspire new lines of research that may be needed to help the field more fully capitalize on this innovation. With additional research, it is hoped that the new multispecifier model will eventually buy clinicians additional information that cannot be gleaned from current diagnostic criteria and will help clinicians and researchers further uncover the factors that promote or protect against the development of CD. This paper delineates the areas of research that will be needed to fully realize the potential of a multispecifier model and ultimately to improve clinical care for children and adolescents with CD.

A Multi-Dimensional, Multi-Informant Examination of Adolescent Psychopathy and its Links to Parental Monitoring: The Moderating Role of Resting Arousal

Recent work indicates clinically meaningful differences in domains of psychopathic personality - such as grandiose-manipulative (GM), callous-unemotional (CU), and daring-impulsive (DI) traits - and parenting factors. Yet, different domains of parenting and reports from multiple informants may vary in their associations to psychopathic traits. This study examined psychopathic traits and their links with parental monitoring behaviors, parental knowledge, and adolescent disclosure. Further, we evaluated whether adolescents' self-reported resting arousal moderated these associations. A mixed clinic-referred/community sample of 134 adolescent-parent dyads (Mage = 14.49; SD = 0.50; 66.4% female) completed multi-dimensional measures of psychopathy, parental monitoring behaviors, parental knowledge, and adolescent disclosure; adolescents also self-reported on their resting arousal. Results indicated links between: (a) increased parent-reported GM traits and decreased parent-reported parental knowledge, and (b) increased parent-reported DI traits and lower parent-reported monitoring behaviors, which were attenuated at high levels of adolescent-reported resting arousal. Associations between elevated dimensions of psychopathic traits and lower levels of parental monitoring behaviors, parental knowledge, and adolescent disclosure were most consistent within-informants, with some cross-informant associations identified for links between elevated GM and DI and lower levels of parental monitoring behaviors and parental knowledge. These findings have important implications for our understanding of how to assess and prevent psychopathy and associated externalizing problems, and suggest that targeting modifiable environmental and psychophysiological factors may be particularly important.

Fast Track Intervention Effects and Mechanisms of Action Through Established Adulthood

Early preventive interventions can improve outcomes in childhood, but the most effective interventions can continue to deliver benefits through the life course. The Fast Track intervention, a randomized controlled trial for children at risk of conduct problems, has lowered psychopathology, substance use problems, and criminality and elevated happiness at age 25. However, research has not studied whether the intervention's effects continue further into established adulthood. In addition, little is known about the mechanisms through which the intervention may affect adult outcomes. We attempted to answer both questions by simultaneously estimating the intervention's direct effect on adult outcomes at age 31 and the intervention's indirect effects on those outcomes via interpersonal, intrapersonal, and academic competencies gained through the intervention. Participants included the Fast Track intervention (n = 445; 72.4% male) and high-risk control samples (n = 446; 66.4% male). Direct and total effects of random assignment to Fast Track on age 31 outcomes were not significant. However, our analyses showed that Fast Track's improvements to interpersonal and intrapersonal skills in childhood served as catalysts for better life outcomes at age 31. Higher interpersonal skills led to fewer externalizing, internalizing, and substance use problems, reduced criminality and sexual partners, in addition to increased general health and full-time employment. Improved intrapersonal skills led to greater strength. There were no significant indirect pathways via academic skills. Our findings inform understanding of how a childhood preventive intervention can improve adjustment and behaviors into established adulthood.

Objective Linguistic Markers Associated with Callous-Unemotional Traits in Early Childhood

BACKGROUND

Callous-unemotional (CU) traits are associated with interpersonal difficulties and risk for severe conduct problems (CP). The ability to communicate thoughts and feelings is critical to social success, with language a promising treatment target. However, no prior studies have examined objective linguistic correlates of childhood CU traits in early childhood, which could give insight into underlying risk mechanisms and novel target treatments.

METHODS

We computed lexical (positive emotion, sad, and anger words) and conversational (interruptions and speech rate) markers produced by 131 children aged 5-6 years (M = 5.98; SD = 0.54, 58.8% female) and their parents while narrating wordless storybooks during two online visits separated by 6-8 weeks (M = 6.56, SD = 1.11; two books, order counterbalanced). Audio recordings were diarized, time-aligned, and orthographically transcribed using WebTrans. Conversational markers were calculated using R and word frequencies were calculated using Linguistic Inquiry and Word Count (LIWC) software. We examined links between child CU traits and linguistic markers, and explored whether relationships were moderated by child sex.

RESULTS

Higher CU traits were associated with fewer positive emotion words produced by parents and children. Higher CU traits were also associated with greater concordance in the degree of interruptions and expression of anger emotion words by parents and children.

CONCLUSIONS

Results suggest that objective linguistic correlates of CU traits are detectable during early childhood, which could inform adjunctive treatment modules that improve outcomes by precisely tracking and targeting subtle communication patterns.

Evidence Base Update on the Assessment of Irritability, Anger, and Aggression in Youth

OBJECTIVE

Irritability, anger, and aggression have garnered significant attention from youth mental health researchers and clinicians; however, fundamental challenges of conceptualization and measurement persist. This article reviews the evidence base for assessing these transdiagnostic constructs in children and adolescents.

METHOD

We conducted a preregistered systematic review of the evidence behind instruments used to measure irritability, anger, aggression, and related problems in youth. Searches were conducted in PsycINFO and PubMed, identifying 4,664 unique articles. Eligibility criteria focused on self- and proxy-report measures with peer-reviewed psychometric evidence from studies in English with youths ages 3-18. Additional measures were found through ancillary search strategies (e.g. book chapters, review articles, test publishers). Measures were screened and coded by multiple raters with acceptable reliability.

RESULTS

Overall, 68 instruments met criteria for inclusion, with scales covering irritability (n = 15), anger (n = 19), aggression (n = 45), and/or general overt externalizing problems (n = 27). Regarding overall psychometric support, 6 measures (8.8%) were classified as Excellent, 46 (67.6%) were Good, and 16 (23.5%) were Adequate. Descriptive information (e.g. informants, scales, availability, translations) and psychometric properties (e.g. reliability, validity, norms) are summarized.

CONCLUSIONS

Numerous instruments for youth irritability, anger, and aggression exist with varying degrees of empirical support for specific applications. Although some measures were especially strong, none had uniformly excellent properties across all dimensions, signaling the need for further research in particular areas. Findings promote conceptual clarity while also producing a well-characterized toolkit for researchers and clinicians addressing transdiagnostic problems affecting youth.

Ten recommendations for reducing the long-term costs of conduct problems: A commentary on the economic analysis of Goulter et al. (2023)

The economic analysis of Goulter et al. (2023) identifies the long-term financial costs arising from conduct problems in the kindergarten period, including those associated with later criminal activity, lost offender productivity, victim costs and government and medical services. These costs are substantial and provide policymakers with a compelling argument for investing in early intervention and prevention of conduct problems. The ultimate goal of reducing the long-term costs of early conduct problems is likely to be achieved only through the coordinated efforts of many stakeholders and diverse courses of action. Outlined here are 10 recommendations for investment that in my view would support progress towards this outcome.

Introduction to the Special Issue: Novel Insights into the Externalizing Psychopathology Spectrum in Childhood and Adolescence from Intensive Longitudinal Data

Externalizing psychopathology is highly prevalent in children and adolescents. Yet, current understanding of the externalizing psychopathology spectrum is predominantly founded on cross-sectional and conventional longitudinal designs. Compared to these designs, intensive longitudinal data have greater ecological validity and provide insight into within-person fluctuations and short-term developmental dynamics. In this Special Issue, we bring together a selection of 10 innovative and original empirical articles to demonstrate the benefits of intensive longitudinal data for understanding the development of the externalizing psychopathology spectrum during childhood and adolescence, as well as one thoughtful commentary from leaders in the externalizing psychopathology field. In this Introduction to the Special Issue, we describe the articles included in this Special Issue in relation to study designs, timescales, samples, and statistical modeling techniques. We conclude by considering the implications of intensive longitudinal data for informing and enhancing our understanding of externalizing psychopathology with child and adolescent samples, as well as critical future research directions.

Child and Adolescent Psychopathology and Subsequent Harmful Behaviors Associated with Premature Mortality: A Selective Review and Future Directions

In the United States (U.S.), premature mortality in adulthood from suicide, alcohol-related disease, and substance overdoses has increased steadily over the past two decades. To better understand these trends, it is necessary to first examine the harmful behaviors that often precede these preventable deaths (i.e., suicidal ideation and attempts, and harmful alcohol and substance use). Representing critical developmental periods in which psychopathology is most likely to emerge, childhood and adolescence provide an informative lens through which to investigate susceptibility to harmful behaviors. This article synthesizes current evidence describing these rising U.S. mortality rates and the prevalence rates of harmful behaviors linked to these types of mortality. A brief selective review of longitudinal research on harmful behaviors in relation to the most relevant categories of child and adolescent psychopathology is then provided. Finally, recommendations for future research and implications for prevention are discussed.

Promoting Empathy and Affiliation in Relationships (PEAR) study: protocol for a longitudinal study investigating the development of early childhood callous-unemotional traits

INTRODUCTION

Children with callous-unemotional (CU) traits are at high lifetime risk of antisocial behaviour. Low affiliation (ie, social bonding difficulties) and fearlessness (ie, low threat sensitivity) are proposed risk factors for CU traits. Parenting practices (eg, harshness and low warmth) also predict risk for CU traits. However, few studies in early childhood have identified attentional or physiological markers of low affiliation and fearlessness. Moreover, no studies have tested whether parenting practices are underpinned by low affiliation or fearlessness shared by parents, which could further shape parent-child interactions and exacerbate risk for CU traits. Addressing these questions will inform knowledge of how CU traits develop and isolate novel parent and child targets for future specialised treatments for CU traits.

METHODS AND ANALYSIS

The Promoting Empathy and Affiliation in Relationships (PEAR) study aims to establish risk factors for CU traits in children aged 3-6 years. The PEAR study will recruit 500 parent-child dyads from two metropolitan areas of the USA. Parents and children will complete questionnaires, computer tasks and observational assessments, alongside collection of eye-tracking and physiological data, when children are aged 3-4 (time 1) and 5-6 (time 2) years. The moderating roles of child sex, race and ethnicity, family and neighbourhood disadvantage, and parental psychopathology will also be assessed. Study aims will be addressed using structural equation modelling, which will allow for flexible characterisation of low affiliation, fearlessness and parenting practices as risk factors for CU traits across multiple domains.

ETHICS AND DISSEMINATION

Ethical approval was granted by Boston University (#6158E) and the University of Pennsylvania (#850638). Results will be disseminated through conferences and open-access publications. All study and task materials will be made freely available on lab websites and through the Open Science Framework (OSF).