Psychopathology and age at onset of conduct problems in juvenile delinquents

Enuresis in young offenders - a study on prevalence and mental health comorbidity

Background

Enuresis is a common disorder in the school-age period, and is often associated with a variety of behavioral, psychological, and social problems. While early studies suggested an association between enuresis and delinquent behavior, there has been no recent research assessing the prevalence of enuresis and its comorbid psychopathology in young offenders. The aim of this study was to therefore assess the prevalence of enuresis and its associated psychiatric comorbidity in incarcerated young offenders.

Methods

The prevalence of past and current enuresis and comorbid psychopathology was assessed using a semi-structured psychiatric interview and self-reports from 366 incarcerated male young offenders [age 14 to 19 years (mean age = 16.4)] from Northern Russia.

Results

Seventy-three (20.0%) adolescents reported a previous history of enuresis, and in addition almost 10% of the youth reported current enuresis symptoms. Delinquent youth with enuresis did not significantly differ from other youth in the prevalence of comorbid psychiatric diagnoses when assessed by a clinical diagnostic interview, but had significantly higher levels of self-reported mental health problems, and suicidal ideation and attempts.

Conclusion

Problems with enuresis are common among delinquent youth and may be associated with increased mental health problems. Given the potentially increased risk for suicidal thoughts and behavior in young offenders with enuresis, comprehensive mental health screening of those who are detected with this condition should be considered in the juvenile justice system.

A Validation Study of the BRIEF-2 Among Kindergarteners and First Graders At-Risk for Behavior Problems

Early identification of executive dysfunction and timely school-based intervention efforts are critical for students at risk for problematic behaviors during early elementary school. The original Behavior Rating Inventory of Executive Functioning (BRIEF) was designed to measure real-world behavioral manifestations of executive functioning, neurocognitive processes critical for school success. With the updated BRIEF-2, independent validation is needed with kindergarten and first grade students at risk for emotional and behavioral disorders. Thus, using item level analyses, we examined the factor structure of the BRIEF-2 Teacher Rating form with 1,112 students. Results indicated little evidence for the original three-index model and supported a modified two-index model, with a Cognitive Regulation Index and an overall Behavior-Emotion Regulation Index. Criterion related validity indicated positive relationships with performance-based executive functioning (Head-Toes-Knees-Shoulders) and later internalizing and externalizing behaviors. We discuss implications of findings for early identification and school-based intervention efforts, as well as future research.

Executive Function in Kindergarten and the Development of Behavior Competence: Moderating Role of Positive Parenting Practices

The present study used data from the Early Childhood Longitudinal Study-Kindergarten Cohort of 2011 (N = 15,827; 51.1% male; 48.4% White, 13.5% Black/African-American, 24.3% Hispanic/Latino, 7.5% Asian, and 6.3% other ethnicity) to examine the unique contribution of specific executive function processes (working memory and cognitive flexibility) at kindergarten entry on externalizing and internalizing behavior problems in spring of kindergarten, after controlling for fall behavior problems and demographic covariates. Due to the transition to elementary school being a critical identification and prevention period, we also focused on examining the moderating role of specific positive parenting practices (i.e., cognitive stimulation, warmth, and behavior management) on associations between child executive function processes and behavioral functioning. Results indicated working memory was negatively associated with parent-reported externalizing and teacher-rated internalizing behavior problems. Further, the association between working memory and parent-rated externalizing problems was moderated by cognitive stimulation, whereas the association between parent-rated internalizing problems was moderated by behavior management. Cognitive flexibility did not have any significant associations. We discuss implications for research and practice on how parenting practices may be leveraged to improve child outcomes.

Factors associated with family involvement in a family-centered care program among incarcerated French adolescents with conduct disorder

PURPOSE

This study aims to identify the patient characteristics that may influence family involvement in a family-centered care program during detention.

DESIGN/METHODOLOGY/APPROACH

Little is known about the needs of incarcerated adolescents and their families. This exploratory study used a cross-sectional design to collect data from incarcerated adolescents with conduct disorder followed in a French outpatient psychiatric department. Logistic regression models were used to identify the sociodemographic, clinical and family characteristics of these incarcerated adolescents that could predict family involvement in their care.

FINDINGS

Among 44 adolescents with conduct disorder, the probability of family involvement during the adolescent's detention was 9.6 times greater (95% CI 1.2-14.4, p = 0.03) for adolescents with no than for those with cannabis substance use disorder, and family involvement decreased with the age of the adolescent (OR = 0.22, 95% CI 0.1-0.9, p = 0.04).

RESEARCH LIMITATIONS/IMPLICATIONS

Increased knowledge of the characteristics of these adolescents and their families is needed to develop programs that will increase family interventions by specialty treatment services during detention.

ORIGINALITY/VALUE

No study has yet been published on French incarcerated adolescents with conduct disorder. As conduct disorder is one of the most important mental health disorders among delinquent adolescents, this study provides knowledge about these adolescents and the need to involve their parents in their care to prevent the further escalation of problem behaviors.

The health of adolescents in detention: a global scoping review

Adolescents detained within the criminal justice system are affected by complex health problems, health-risk behaviours, and high rates of premature death. We did a global synthesis of the evidence regarding the health of this population. We searched Embase, PsycINFO, Education Resources Information Center, PubMed, Web of Science, CINCH, Global Health, the Cochrane Database of Systematic Reviews, the Campbell Library, the National Criminal Justice Reference System Abstract Database, and Google Scholar for peer-reviewed journal articles, including reviews, that reported the prevalence of at least one health outcome (physical, mental, sexual, infectious, and neurocognitive) in adolescents (aged <20 years) in detention, and were published between Jan 1, 1980, and June 30, 2018. The reference lists of published review articles were scrutinised for additional relevant publications. Two reviewers independently screened titles and abstracts, and three reviewed full texts of relevant articles. The protocol for this Review was registered with PROSPERO (CRD42016041392). 245 articles (204 primary research articles and 41 reviews) were included, with most primary research (183 [90%]) done in high-income countries. A high lifetime prevalence of health problems, risks, and conditions was reported in detained adolescents, including mental disorders (0–95%), substance use disorders (22–96%), self-harm (12–65%), neurodevelopmental disabilities (2–47%), infectious diseases (0–34%), and sexual and reproductive conditions (pregnant by age 19 years 20–37%; abnormal cervical screening test result 16%). Various physical and mental health problems and health-risk behaviours are more common among adolescents in detention than among their peers who have not been detained. As the social and structural drivers of poor health overlap somewhat with factors associated with exposure to the criminal justice system, strategies to address these factors could help to reduce both rates of adolescent detention and adolescent health inequalities. Improving the detection of mental and physical disorders, providing appropriate interventions during detention, and optimising transitional health care after release from detention could improve the health outcomes of these vulnerable young people.

Inhalant Use and Mental Health Problems in Russian Juvenile Delinquents

BACKGROUND

Inhalant use by children and adolescents has been linked to an increased risk of multiple drug use, mental health problems and antisocial behavior.

OBJECTIVES

The purpose of this study was to examine the association between the frequency of inhalant use and psychiatric diagnoses among incarcerated delinquent youths in Russia.

METHODS

A total of 370 incarcerated delinquents from a juvenile correction center in Northern Russia were assessed by means of a semi-structured psychiatric interview and by self-reports.

RESULTS

Compared to non-users (N = 266), inhalant users (N = 104) reported higher rates of PTSD, early onset conduct disorder, ADHD, alcohol abuse and dependence, as well as higher levels of antisocial behavior, impulsiveness and more psychopathic traits. Frequent inhalant users also reported the highest rates of co-occurring psychopathology.

CONCLUSIONS

Our findings suggest that inhalant use in delinquents is frequent and may require additional clinical measures to address the issue of psychiatric comorbidity.

Comorbidities and correlates of conduct disorder among male juvenile detainees in South Korea

BACKGROUND

The purpose of this study was to examine the rate and distribution of comorbidities, severity of childhood maltreatment, and clinical characteristics of adolescents with conduct disorder detained in a juvenile detention center in South Korea.

METHODS

In total, 173 juvenile detainees were recruited. We analyzed the distribution of psychiatric disorders among the sample and compared the rate of comorbidities between groups with and without conduct disorder. We compared the two groups in terms of demographic and clinical characteristics, as well as severity of childhood maltreatment and psychiatric problems, using the Young Self Report (YSR) scale.

RESULTS

A total of 95 (55%) of the detainees were diagnosed with conduct disorder, and 93 (96.9%) of them had at least one comorbid axis I psychiatric disorder. Detainees with conduct disorder had a higher number of comorbid psychiatric disorders; a higher rate of violent crime perpetration; had suffered more physical, emotional, and sexual abuse; and showed higher total YSR scores and externalizing behavior, somatic complaints, rule-breaking behavior, and aggressive behavior YSR subscale scores.

CONCLUSIONS

Conduct disorder is a common psychiatric disorder among juvenile detainees in South Korea, who tend to commit more violent crimes and show more psychopathology than detainees who do not have conduct disorder. These findings highlight the importance of diagnosing and intervening in conduct disorder within the juvenile detention system.

Exploring possible association between DβH genotype (C1021T), early onset of conduct disorder and psychopathic traits in juvenile delinquents

Early onset of conduct disorder (CD) with callous-unemotional traits has been linked to low levels of dopamine β-hydroxylase (DβH), an enzyme involved in dopamine turnover. The C1021T polymorphism in the DβH gene is a major quantitative-trait locus, regulating the level of DβH. In this study of juvenile delinquents from Northern Russia (n = 180), the polymorphism at -1021 was associated neither with early-onset CD nor with psychopathic traits. Association was found between psychopathic traits and early-onset CD, ADHD and mania.

Delinquent and Aggressive Behavior and Social Desirability Among Roma and Non-Roma Adolescents in Slovakia: A Cross-Sectional Study

Rates of aggression and delinquency are assumed to be higher among Roma and other minorities, but sound evidence of this is lacking. Our aim was to assess delinquent and aggressive behavior among Roma and non-Roma adolescents and the effects on ethnic differences of parental education and social desirability. We conducted a cross-sectional study among Roma from separated and segregated settlements in the eastern part of Slovakia (N = 330; Mage = 14.50; interview) and non-Roma adolescents (N = 722; Mage = 14.86; questionnaire). The effect of ethnicity on antisocial behaviors was analyzed using linear regression (crude) and adjusted for gender, parental education, and social desirability. Adjustment for social desirability diminished the ethnic differences in delinquency (B = 1.08; 95% confidence interval [CI] = [2.12, -0.04]), led to an increase in the differences in hostility (B = 2.43; 95% CI = [0.87, 3.99]), and led to the disappearance of differences in physical aggression (B = 0.45; 95% CI = [1.14, 2.07]). Parental education did not affect the associations in an important way. Our findings indicate that Roma are not that much different from non-Roma, in terms of antisocial behavior, which contradicts the general perception of Roma. Our findings should be confirmed in other settings.

Parenting and problem behaviors in children of substance abusing parents

BACKGROUND

This study examined parenting practices, parental stress, and problem behaviors among urban Children of Substance Abusing Parents.

METHOD

One hundred and seven children completed the Child Rating Scale and the Children's Depression Inventory. Parents completed the Parenting Practices Scale-Parent Version, Parenting Stress Index, and internalizing and externalizing scales on the Parent Observation of Classroom Adaptation.

RESULTS

Structural Equation Modeling findings support an indirect effects pathway in which unfavorable parenting practices predict parental stress and parental stress predicts internalizing and externalizing behaviors.

CONCLUSION

The results argue for assessing parental stress and including activities to improve the parent-child bond in family intervention programs.

The usefulness of DSM-IV and DSM-5 conduct disorder subtyping in detained adolescents

The aim of this study was to test whether the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), and DSM-5 conduct disorder (CD) subtyping approaches identify adolescents with concurrent psychiatric morbidity and an increased risk to reoffend. A diagnostic interview was used to assess childhood-onset CD (CoCD), adolescent-onset CD (AoCD), and concurrent psychiatric morbidity in 223 detained male adolescents. The callous-unemotional (CU) specifier was established through a self-report questionnaire. Two to four years later, information on official criminal recidivism was collected. The CoCD and AoCD youths were different in concurrent psychiatric morbidity but not in their risk to reoffend. The youths with CD and CU (CD+CU) and the CD-only youths did not differ with regard to concurrent psychiatric morbidity. In addition, the CD+CU youths were at risk to reoffend but merely when compared with their counterparts without CD/CU. Although CD subtyping approaches may identify youths with concurrent psychiatric morbidity, the usefulness to predict recidivism in already delinquent youths is limited.

Early detection of children at risk for antisocial behaviour using data from routine preventive child healthcare

Background

Youth antisocial behaviour is highly prevalent. Young people are usually not willing to disclose such behaviour to professionals and parents. Our aim was to assess whether child health professionals (CHP) working in preventive child healthcare could identify pre-adolescents at risk for antisocial behaviour through using data that they obtain in routine practice.

Methods

CHPs examined a national sample of 974 pre-adolescents aged 8-12 years (response 79.1%), and interviewed parents and children during routine well-child assessments. We obtained data on family background and current health of the child from the CHP; on developmental concerns from parents, and on social and emotional well-being, injuries, and substance use from the children. Antisocial behaviour concerned the adolescent-reported 15 item International Self-Reported Delinquency study questionnaire, among which are 5 items on violence against people.

Results

The prevalence of 2+acts of any antisocial behaviour was 21.8%, and 33.9% for 1+acts of violence (10.5% for 2+). Children who were male, had a young mother, no parent employed, recent injuries, poor performance at school or who were bored by school, and who had parental concerns more often reported 2+antisocial acts and 1+violence against people. Detection algorithms on the basis of these variables were moderately able to classify outcomes, with Areas-Under-the-Curves ranging from 0.66 to 0.71.

Conclusions

Data from routine well-child assessment can help CHPs to detect pre-adolescents at risk for antisocial behaviour, but detection algorithms need to be further improved. This could be done by obtaining additional information on factors that are associated with antisocial behaviour.

The association between early conduct problems and early marijuana use in college students

Early conduct problems have been linked to early marijuana use in adolescence. The present study examines this association in a sample of 1,076 college students that was divided into three groups: 1) early marijuana users (began marijuana use prior to age 15; n=126), 2) late marijuana users (began marijuana use at or after age 15; n=607), and 3) non-users (never used marijuana; n=343). A conduct problem inventory used in previous studies was adapted for use in the present study. Early conduct problems were associated with early marijuana use but not with late marijuana use, holding constant other risk factors. Results suggest that early conduct problems are a risk factor for early marijuana use even among academically-achieving college-bound students.

Psychiatric disorders in detained male adolescents: a systematic literature review

OBJECTIVE

To provide a best estimate of the prevalence of psychiatric disorders among detained male adolescents, with particular emphasis on impairment, multi-informant assessment, and race or ethnicity.

METHOD

Computer-assisted searches were executed to identify relevant studies.

RESULTS

Fifteen studies using adolescents as informants met inclusion criteria (n = 3401), of which only 2 reported within a subsample on parent-derived diagnoses. The mean prevalence of any disorder was 69.9% (95% CI 69.5% to 70.3%); with conduct disorder occurring most frequently (46.4%, 95% CI 45.6% to 47.3%), followed by substance use disorder (45.1%, 95% CI 44.6% to 45.5%), oppositional defiant disorder (19.8%, 95% CI 19.2% to 20.3%), and attention-deficit hyperactivity disorder (13.5%, 95% CI 13.2% to 13.9%). Although lower, rates for internalizing disorders were still substantial, with any anxiety disorder found in 15.9% (95% CI 15.6% to 16.1%), major depression in 12.0% (95% CI 11.7% to 12.2%), and posttraumatic stress disorder in 9.6% (95% CI 9.2% to 10.0%). Three studies reported on psychotic disorders, finding low rates (1.35%, 95% CI 1.32% to 1.39%). Estimates of prevalence were only marginally different when impairment was not required, while consistency between adolescents and parents was poor. Findings on the relations between race or ethnicity were too scarce and inconsistent to interpret.

CONCLUSION

Detained male adolescents bear substantial mental health needs, emphasizing the need to organize effective mental health services for this troubled group. However, our knowledge on mental disorders in detained youth should be enhanced, in particular regarding the reliability of adolescents, compared with parent report, and whether clinically relevant differences exist by race or ethnicity.

The relationship between attention deficit hyperactivity disorder, conduct disorder, and psychopathy in adolescent male and female detainees

Although ADHD and CD are apparent risk factors for adult psychopathy, there are three distinct perspectives regarding their relationships to psychopathy: (1) ADHD may contribute uniquely to the development of psychopathy or (2) its contribution may reflect its high comorbidity with CD. Alternatively, (3) the comorbid presence of ADHD and CD may confer unique risk for the development of psychopathy. Although prior adult studies have yielded conflicting findings, no prior studies of adolescents address this issue. We examined these three hypotheses and the possibility of sex differences using cross-sectional analyses in 90 male and 123 female incarcerated adolescents. Among males the influence of ADHD was largely attributable to the overlap between ADHD and CD, whereas among females ADHD contributed independently to psychopathy scores and to scores on several dimensions of psychopathy. In addition, among females, the ADHD x CD interaction was significant for the total score and the antisocial component of psychopathy and in a direction opposite to that predicted by the comorbid subtype hypothesis. These findings indicate that there may be sex-specific pathways to elevations in psychopathic traits and suggest that the comorbid subtype hypothesis is probably not correct for either boys or girls.

Psychiatric disorders in property, violent, and versatile offending detained male adolescents

This study examines the past year prevalence rate of psychiatric disorders in detained male adolescents and the relation between psychiatric disorders and type of offending. The Diagnostic Interview Schedule for Children (DISC-IV) was administered in a sample (N = 245) of male detained adolescents aged 12 to 17 years. Based on lifetime official criminal history, participants were classified into property, violent, and versatile subgroups. High rates of psychiatric disorders were found in all groups. In addition, property offenders reported significantly higher rates of depression, disruptive behavior disorders, substance use disorders and comorbidity than violent and versatile offenders. Overall, versatile offenders did not differ from violent offenders, with the exception of more marijuana use disorder found in violent offenders. This study once more emphasizes that detained boys have substantial mental health needs, a finding that is generalizable across countries. In addition, the current study suggests that classifying detained juveniles by offense subgroups may carry clinical relevance. The long-term impact of these differences, and the possible effects of intervention, should be subject of further research.

Development and validation of the outburst monitoring scale for children and adolescents

OBJECTIVE

The aim of this study was to develop a parent-completed questionnaire measure of specific types of aggressive behaviors in children and adolescents.

METHOD

Two studies tested the psychometrics of the Outburst Monitoring Scale (OMS), a questionnaire measure of verbal, property, self, and physical aggression, based in part on the categories of the Overt Aggression Scale. In Study 1, parents of 23 adolescents with a history of aggressive-disruptive behavior and 30 control adolescents completed the OMS and other measures of aggressive-disruptive behavior. In Study 2, parents of 9 adolescents with a history of aggressive-disruptive behavior completed the OMS and other measures of aggressive-disruptive behavior during open-label treatment with methylphenidate and quetiapine.

RESULTS

Results from both studies demonstrated adequate internal consistency of OMS subscale and total scores. OMS scores correlated significantly with measures of conduct disorder and oppositional defiant disorder and differentiated between control and aggressive sub-samples. Changes in OMS scores during treatment correlated with changes in other measures of aggressive and disruptive behavior.

CONCLUSION

The OMS demonstrated good internal consistency, strong correlations with other measures of aggressive/disruptive behavior, good differential validity, and sensitivity to change during a medication trial. The OMS offers a quick, valid, questionnaire-based alternative for measuring frequencies of specific aggressive behaviors in clinical and research settings.

Quetiapine addition in methylphenidate treatment-resistant adolescents with comorbid ADHD, conduct/oppositional-defiant disorder, and aggression: a prospective, open-label study

OBJECTIVE

This study investigated the safety and efficacy of adding the atypical antipsychotic quetiapine to ongoing OROS methylphenidate treatment for adolescents with comorbid ADHD and severe aggression that were incompletely responsive to methylphenidate monotherapy.

METHOD

Participants aged 12-16 years were enrolled in a prospective, open-label trial consisting of 3 weeks of OROS methylphenidate monotherapy titrated to 54 mg/day, followed by 9 weeks of combination treatment with quetiapine and methylphenidate. Twenty-four out of thirty participants failed to meet criteria for significant improvement (Clinical Global Improvement-Severity [CGI-S] and Rating of Aggression Against People and Property [RAAPP] scale scores of 1 or 2 and ADHD-Rating Scale: Investigator Administered and Scored [ADHD-RS-I] score less than 50% of baseline score) with methylphenidate treatment alone and received combined treatment.

RESULTS

Investigator and parent ratings of ADHD symptoms, aggression, and global functioning improved significantly during both methylphenidate monotherapy treatment and during combined methylphenidate-quetiapine treatment. At the conclusion of combined treatment, 42% of the sample met all criteria for clinically significant improvement and 79% showed minimal aggression. Mild and transient sedation was reported by about half the cases. Weight loss (0.9 kg) during methylphenidate treatment was offset by weight gain (1.2 kg) during combination treatment.

CONCLUSION

Quetiapine addition to methylphenidate was effective in reducing ADHD and aggression in individuals who did not respond sufficiently (based on CGI-S, RAAPP, and ADHD-RS-I criteria for significant improvement) to OROS methylphenidate alone at a 54-mg/day dose.

Parent-of-origin effects in attention-deficit hyperactivity disorder

The goal of the present study was to investigate parent-of-origin effects in attention-deficit hyperactivity disorder (ADHD). Parent-of-origin effects in ADHD may be due to differences in the relative quantity of risk factors transmitted by each parent. Alternatively, parent-of-origin effects may be produced by qualitative differences in the risks transmitted, such as those carried on the sex chromosomes or regulated by genomic imprinting. 60 children with maternal-only history of ADHD and 131 children with paternal-only history of ADHD were compared on three domains for which prior evidence suggested parent-of-origin effects may exist: core symptoms, disruptive behaviours and depression. Dependent variables were derived from previously validated, age-appropriate and standardized parent and teacher interviews and questionnaires. Depression levels were rated using the Child Depression Inventory. Consistent with previous research and the predictions derived from threshold models of ADHD etiology, the maternal history group received higher ratings of behavioural disorder (ADHD, conduct disorder and oppositional symptoms) than the paternal history group. Parent-of-origin effects were also observed for depression, with the paternal history group rating themselves as significantly more depressed than children in the maternal history group, particularly girls. Heightened paternal transmission relative to maternal is suggestive of genomic imprinting, and the interaction with proband sex indicates the involvement of the sex chromosomes or sex-specific physiological or hormonal factors. Interpretations of these data in terms of environmental and genetic factors, including epigenetic and sex-linked hypotheses, are explored.

Relating psychiatric disorders, offender and offence characteristics in a sample of adolescent sex offenders and non-sex offenders

INTRODUCTION

Several studies have paid attention to the relationship between psychiatric disorders and adolescent offending but few have distinguished different types of offenders, especially within the category of youngsters who have committed sex offences.

AIM

To test for relationships between psychiatric disorder and specific offence category among young male offenders.

METHOD

Nationwide data were extracted from Dutch Forensic Psychiatric Services (FPD) files for five groups of offenders, as defined by their index offence: 308 violent sex offenders; 134 non-violent sex-offenders; 270 sex offenders against children; 3148 violent offenders and 1620 offenders charged with any crime other than interpersonal body contact crimes. They were compared on individual characteristics and psychiatric diagnoses according to DSM-IV criteria. Having a diagnosis of a paraphilia alone was exclusively associated with sex offending, therefore all such youths were excluded from further analyses. The OVERALS technique was used to explore possible relationships between offence, psychiatric diagnoses, sociodemographic and individual characteristics among the remaining young men for whom all pertinent data were available (n = 1894).

RESULTS

Sex offenders constituted a distinct group of juvenile delinquents. Developmental disorders were more common among non-violent sex offenders and child molesters. Violent offences were more typical of delinquents from immigrant backgrounds.

CONCLUSION

Group differences in types of psychiatric diagnoses may reflect differences in aetiological factors for the various types of sexual and other delinquent behaviour, and this would be worthy of further study.

Mental health service provision in juvenile justice facilities: pre- and postrelease psychiatric care

High prevalence rates of mental illness among adolescents in juvenile justice facilities require multifaceted interventions. Children entering justice systems are frequently underserved and having their first contact with psychiatric services. Programming must be multidisciplinary and multifaceted, combining treatment within the facility with postrelease planning. It examines the role of the psychiatrist and the structure of mental health services within juvenile justice facilities.

Mental health problems in juvenile justice populations

The limited literature on mental health problems in juvenile justice population has reported that most youth in juvenile justice hold psychiatric pathology. Although conduct disorder and substance abuse are the most prevalent conditions in this population, many other diagnoses can be found at alarmingly high rates; research on other diagnoses (eg, autism, psychosis) is limited. This finding underscores the necessity of implementing adequate diagnostic assessment within forensic settings and of developing interventions programs that take into account the presence of psychiatric problems.

Neurocognitive skills moderate urban male adolescents' responses to preventive intervention materials

The present experiment was designed to determine whether individual variation in neurobiological mechanisms associated with substance abuse risk moderated effects of a brief preventive intervention on social competency skills. This study was conducted in collaboration with the ongoing preventive intervention study at Johns Hopkins University Prevention Intervention Research Center (JHU PIRC) within the Baltimore City Public Schools. A subsample (N = 120) of male 9th grade students was recruited from the larger JHU study population. Approximately half of the participants had a current or lifetime diagnosis of CD while the other half had no diagnosis of CD or other reported problem behaviors. Measures of executive cognitive function (ECF), emotional perception and intelligence were administered. In a later session, participants were randomly assigned to either an experimental or control group. The experimental group underwent a facilitated session using excerpted materials from a model preventive intervention, Positive Adolescent Choices Training (PACT), and controls received no intervention. Outcomes (i.e., social competency skills) were assessed using virtual reality vignettes involving behavioral choices as well as three social cognition questionnaires. Poor cognitive and emotional performance and a diagnosis of CD predicted less favorable change in social competency skills in response to the prevention curriculum. This study provides evidence for the moderating effects of neurocognitive and emotional regulatory functions on ability of urban male youth to respond to preventive intervention materials.

Familial risks, conduct disorder and violence

OBJECTIVE

The aim was to investigate the impact of familial risk factors on the development of violent behaviour and conduct disorder (CD) by gender in a sample of adolescent psychiatric patients.

METHODS

The study sample consisted of 278 adolescents (age 12-17) consecutively admitted to psychiatric inpatient care between April 2001 and January 2004. DSMIV psychiatric diagnoses were obtained from the Schedule for Affective Disorders and Schizophrenia for School Aged Children-Present and Lifetime (K-SADS-PL).

RESULTS

Logistic regression analyses revealed that girls who had been physically abused at home had a 4.2-fold risk of having conduct disorder with violent behaviour (95% CI 1.4-12.2) compared to those not exposed to domestic violence. A broken primary family also increased the risk for having both violent CD (OR 7.8 95 % CI 1.7-36.4) and non-violent CD (OR 7.0 95% CI 1.5-33.5) among girls. Among boys, no statistically significant association was found between any familial risk factors and later CD.

CONCLUSIONS

The results suggest that being physically abused by parents may influence the development of conduct disorder including violent behaviour among girls. This emphasizes the importance of early recognition of domestic violence. In girls, the absence of primary family seems to associate strongly with the development of CD, and should be taken into consideration by physicians and other professionals working with young people.

Media violence exposure and executive functioning in aggressive and control adolescents

The relationship between media violence exposure and executive functioning was investigated in samples of adolescents with no psychiatric diagnosis or with a history of aggressive-disruptive behavior. Age-, gender-, and IQ-matched samples of adolescents who had no Diagnostic and Statistical Manual of Mental Disorders-fourth edition (DSM-IV; American Psychiatric Association, 1994) diagnosis (N = 27) and of adolescents who had DSM-IV Disruptive Behavior Disorder diagnoses (N = 27) completed measures of media violence exposure and tests of executive functioning. Moderate to strong relationships were found between higher amounts of media violence exposure and deficits in self-report, parent-report, and laboratory-based measures of executive functioning. A significant diagnosis by media violence exposure interaction effect was found for Conners' Continuous Performance Test scores, such that the media violence exposure-executive functioning relationship was stronger for adolescents who had Disruptive Behavior Disorder diagnoses. Results indicate that media violence exposure is related to poorer executive functioning, and this relationship may be stronger for adolescents who have a history of aggressive-disruptive behavior.

Psychopathology in the offspring of parents with bipolar disorder: a controlled study

BACKGROUND

To examine the risk for psychopathology in offspring at risk for bipolar disorder and the course of psychiatric disorders in these youth.

METHODS

Using structured diagnostic interviews (Structured Clinical Interview for DSM-IV [SCID] and Kiddie Schedule for Affective Disorders and Schizophrenia [K-SADS]), psychiatric diagnoses of 117 nonreferred offspring of parents with diagnosed bipolar disorder were compared with those of 171 age- and gender-matched offspring of parents without bipolar disorder or major depression.

RESULTS

Compared with offspring of parents without mood disorders, high-risk youth had elevated rates of major depression and bipolar disorder, anxiety, and disruptive behavior disorders. High-risk offspring also had significantly more impaired Global Assessment of Functioning (GAF) scores, higher rates of psychiatric treatment, and higher rates of placement in special education classes. Disruptive behavior disorders, separation anxiety disorder, generalized anxiety disorder (GAD), social phobia, and depression tended to have their onset in early or middle childhood, whereas bipolar disorder, obsessive-compulsive disorder (OCD), panic disorder, and substance use disorder had onset most frequently in adolescence.

CONCLUSIONS

These findings support the hypothesis that offspring of parents with bipolar disorder are at significantly increased risk for developing a wide range of severe psychiatric disorders and accompanying dysfunction. Early disruptive behavior and anxiety disorders, as well as early-onset depression, may be useful markers of risk for subsequent bipolar disorder in high-risk samples.

Alcohol abuse in Russian delinquent adolescents. Associations with comorbid psychopathology, personality and parenting

INTRODUCTION

Adolescent delinquency and alcohol abuse have become a growing concern in Russia. Psychopathology, a dysfunctional family and specific personality factors have all been linked to addictive and antisocial behavior. Since delinquent youth represent a specific risk group, where alcohol misuse tends to be more pronounced than in the general population, the objectives of this study were: 1) to compare differences in personality and parenting factors, and in psychopathology in juvenile delinquents with and without alcohol abuse; and 2) to evaluate the associations between alcohol abuse, personality and parenting factors, after controlling for comorbid psychopathology.

METHODS

Psychopathology, including alcohol abuse, was assessed by means of a psychiatric interview in 229 Russian incarcerated male juvenile delinquents. In addition, alcohol use, personality, and parenting factors were assessed by self-reports.

RESULTS

Alcohol-abusing delinquents (n=138) scored significantly higher on novelty seeking and maternal emotional warmth and reported higher levels of psychopathology, as compared to nonalcohol-abusing delinquents (n=91). Logistic regression analysis demonstrated that personality and parenting factors were significantly related to alcohol abuse, even after controlling for comorbid psychopathology.

CONCLUSION

Alcohol-abusing delinquents are at risk for a wide spectrum of psychiatric disorders. Alcohol abuse is associated with personality and parenting factors independently of comorbid psychopathology. Early interventions with high-risk youths may help to reduce their psychiatric problems and alcohol abuse.

Platelet MAO-B, personality, and psychopathology

The article investigates the relationships between platelet monoamine oxidase-B (MAO-B) activity, personality, and psychopathology (Diagnostic and Statistical Manual of Mental Disorders [4th ed.; American Psychiatric Association, 1994] diagnoses. These relationships were assessed in 178 incarcerated male juvenile delinquents. Even after controlling for smoking, the authors found that both Internalizing and Externalizing Psychopathology were negatively related to MAO-B activity. In the final reduced model, novelty seeking fully mediated the relationships between MAO-B and Externalizing Psychopathology but not between MAO-B and Internalizing Psychopathology. It was hypothesized that low platelet MAO-B activity does not directly predispose individuals to psychopathology but is related to specific personality traits, which in turn represent a vulnerability factor for psychopathology. Future studies should help clarify the nature of the relationships between personality, biological markers, and psychopathology.