Links between Oppositional Defiant Disorder Dimensions, Psychophysiology, and Interpersonal versus Non-interpersonal Trauma

The etiology of oppositional defiant disorder (ODD) is not well understood but appears to have both biologically-based roots and can develop following adverse experiences. The current study is the first to examine the interaction between biologically-based factors and type of trauma experience (i.e., interpersonal and non-interpersonal) and associations with ODD. The psychophysiological factors included baseline resting heart rate, respiratory sinus arrhythmia (RSA), and cortisol. ODD was measured as two dimensions of irritable and defiant/vindictive. The sample included 330 children, 3-7 years-old, oversampled for a history of trauma. Results showed the interactions between baseline physiological arousal variables and trauma type in predicting ODD dimensions were not supported. However, the baseline RSA by trauma interaction was a significant predictor of defiance/vindictiveness among boys, but not girls, when interpersonal trauma was compared to controls. Several other gender differences emerged. Among boys, both interpersonal and non-interpersonal trauma were predictive of ODD dimensions; however, among girls, non-interpersonal trauma was not. Among girls, there was a significant negative bivariate relationship between baseline cortisol and irritability. Also, when the sample was restricted to those with interpersonal trauma only and controls, baseline RSA was negatively associated with irritability in girls only (controlling for trauma). Finally, retrospective reports revealed that children who met criteria for ODD diagnosis and experienced interpersonal trauma were more likely to exhibit ODD symptoms prior to their trauma compared to those who experienced non-interpersonal trauma. Results are discussed in the context of previous mixed findings, and avenues for future research are highlighted.

Employing the Risk-Need-Responsivity (RNR) model and predicting successful completion in an alternative drug court program: Preliminary findings from the Orleans Parish Drug Court

Drug courts have been in operation for decades to provide treatment alternatives to individuals whose substance use and related behaviors have brought them into contact with the criminal justice system. As research on drug courts have evolved, it has been demonstrated that different types of offenders have different mental health and substance use treatment needs. One way of approaching treatment in court-mandated substance use treatment is by the application of the risk-need-responsivity (RNR) model (Andrews, Zinger et al., 1990). The Orleans Parish Drug Court expanded assessment and treatment services to determine whether the implementation of alternative substance use programming within a traditional drug court model improved outcomes. The goals of the current study were to describe the process of implementing risk and need principles, provide a description of client characteristics, examine the factors related to successful completion of drug court, and investigate completion rates across risk and need groups. Results demonstrated that risk and need groups differed on several demographic variables, levels of substance use, mental health concerns, and legal issues, suggesting assessment and triage procedures were successful. Comparisons between individuals who successfully completed drug court and those who were terminated prematurely also showed significant differences. Specifically, baseline age, education, substance use problems and frequency, and days in jail/prison were unique predictors of successful drug court completion. Finally, as predicted, individuals in the group with the lowest risk and need had the highest graduation rate, despite receiving less intensive services. Overall, creation of specialized treatment tracks within a traditional drug court program appears to be an effective strategy to target the wide range of offenders typical of drug court participants.

An Epidemiologic Study of COVID-19 Patients in a State Psychiatric Hospital: High Penetrance With Early CDC Guidelines

OBJECTIVE

This study aimed to explore the transmission of COVID-19 in a U.S. state psychiatric hospital setting.

METHODS

Symptomatic and asymptomatic patients were tested throughout a large psychiatric hospital to determine penetrance. The hospital followed initial Centers for Disease Control and Prevention (CDC) guidelines.

RESULTS

Seventy-eight percent (N=51 of 65) of tested patients in the building where the first positive patient was housed (building zero) tested positive for COVID-19. Eighty-eight percent (N=14 of 16) of tested asymptomatic patients in building zero were positive, compared with 12% (N=6 of 51) of randomly selected asymptomatic patients in a sample from the rest of the hospital.

CONCLUSIONS

A high percentage of patients can become positive for COVID-19 despite following initial CDC guidelines. As such, use of masks by all patients in close-quarter settings prior to the first positive case appears warranted. Recent CDC guidelines align with this strategy.

Psychometric Properties of a Semistructured Interview to Assess Limited Prosocial Emotions

Callous-unemotional (CU) traits have recently been added to the diagnostic criteria of Conduct Disorder in the Diagnostic and Statistical Manual of Mental Disorders-Fifth edition and of conduct-dissocial and oppositional defiant disorders in the International Classification of Disease-Eleventh edition as the limited prosocial emotions specifier. This change necessitates the assessment of these traits with validated measures in both research and clinical contexts. The current study sought to validate a semi-structured diagnostic interview method, the Michigan Limited Prosocial Emotion Addendum (M-LPE) to the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version, of assessing CU traits based on a recently developed clinician rating system (Clinical Assessment of Prosocial Emotions, Version 1.1) in a sample of at-risk youth. Results supported the interrater reliability of the M-LPE with moderate agreement and high reliability between raters. The M-LPE demonstrated convergent and incremental validity with CU traits and various measures of antisocial behavior. The results provide preliminary evidence for the use of a semi-structured interview assessment of CU traits in research contexts and build the foundation for further validation.

Examining the Prospective Relationship between Pre-Disaster Respiratory Sinus Arrhythmia and Post-Disaster Posttraumatic Stress Disorder Symptoms in Children

Previous studies have examined the concurrent relationship between posttraumatic stress disorder (PTSD) and a range of psychophysiological variables, including respiratory sinus arrhythmia (RSA). However, there is a lack of research examining the prospective development of trauma symptomatology, and the directionality of the association between RSA level and PTSD has yet to be determined. The current study is the first prospective study to examine whether RSA level and RSA reactivity are risk factors for PTSD symptoms in children. Assessments were conducted both prior to (Time 1) and following (Time 2) a natural disaster (i.e., Hurricane Katrina). Participants were 36 children who were 3-6 years-old during the Time 1 assessment. Structured diagnostic interviews were used to assess PTSD symptoms at both Time 1 and Time 2. RSA level during a neutral stimulus, RSA reactivity to emotional video stimuli (distress, joy, and trauma videos) and RSA reactivity to memory stimuli (remote happy memory, trauma memory, mother's recall of the trauma memory) were also collected at both time points. Time 1 RSA level during a neutral stimulus was a significant predictor of Time 2 PTSD symptoms (controlling for age, Time 1 PTSD symptoms, Time 2 neutral RSA level), such that lower RSA during a neutral condition was related to higher PTSD symptoms. Also, Time 1 RSA reactivity in response to memory (but not video) stimuli, in the form of relatively less vagal withdrawal, was a significant predictor of more Time 2 PTSD symptoms (controlling for age, Time 1 PTSD symptoms, Time 2 RSA reactivity). This unique prospective study provides evidence for level of RSA and RSA reactivity as pre-existing clinical markers of stress sensitivity that predict psychopathology following a trauma.

Home Environmental and Behavioral Risk Indices for Reading Achievement

The goal of this study was to identify home environmental and temperament/behavior variables that best predict standardized reading comprehension scores among school-aged children. Data from 269 children aged 9-16 (M = 12.08; SD = 1.62) were used in discriminant function analyses to create the Home and Behavior indices. Family income was controlled in each index. The final Home and Behavior models each classified around 75% of cases correctly (reading comprehension at grade level vs. not). Each index was then used to predict other outcomes related to reading. Results showed that Home and/or Behavior accounted for 4-7% of the variance in reading fluency and spelling and 20-35% of the variance in parent-rated problems in math, social anxiety, and other dimensions. These metrics show promise as environmental and temperament/behavior risk scores that could be used to predict and potentially screen for further assessment of reading related problems.

Oppositional defiant disorder dimensions: genetic influences and risk for later psychopathology

BACKGROUND

This study was undertaken to determine how well two oppositional defiant disorder (ODD) dimensions (irritable and headstrong/hurtful) assessed in childhood predict late adolescent psychopathology and the degree to which these outcomes can be attributed to genetic influences shared with ODD dimensions.

METHODS

Psychopathology was assessed via diagnostic interviews of 1,225 twin pairs at ages 11 and 17.

RESULTS

Consistent with hypotheses, the irritable dimension uniquely predicted overall internalizing problems, whereas the headstrong/hurtful dimension uniquely predicted substance use disorder symptoms. Both dimensions were predictive of antisocial behavior and overall externalizing problems. The expected relationships between the irritable dimension and specific internalizing disorders were not found. Twin modeling showed that the irritable and headstrong/hurtful dimensions were related to late adolescent psychopathology symptoms through common genetic influences.

CONCLUSIONS

Symptoms of ODD in childhood pose a significant risk for various mental health outcomes in late adolescence. Further, common genetic influences underlie the covariance between irritable symptoms in childhood and overall internalizing problems in late adolescence, whereas headstrong/hurtful symptoms share genetic influences with substance use disorder symptoms. Antisocial behavior and overall externalizing share common genetic influences with both the irritable and headstrong/hurtful dimensions.

Patient Characteristics and Outcomes Related to Successful Outpatient Competency Restoration

Criminal defendants have a fundamental right to a fair and speedy trial. However, individuals found incompetent to stand trial are unable to move forward in the adjudication process and are often mired in protracted legal proceedings. If competency restoration is statutorily permissible and can be conducted in the outpatient setting, we propose that it should be considered based on burgeoning empirical data. We present data from an outpatient forensic clinic in which individuals are conditionally released to receive competency restoration in the community. Results indicated that three variables, including being single/never married, having comorbid intellectual disability and mental illness, and having one's conditional release revoked, were negatively related to successful restoration. The final model explained approximately one-third of the variance in restorability and correctly classified 75% of cases. Results demonstrate that individuals can be safely released to the community and successfully restored to competency in the outpatient setting. Utilizing outpatient competency restoration would not only reduce strain on inpatient facilities, but would also reduce the cost of treatment. Copyright © 2017 John Wiley & Sons, Ltd.

Evaluating Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Posttraumatic Stress Disorder Diagnostic Criteria in Older Children and Adolescents

OBJECTIVES

Few studies have assessed how the diagnostic criteria for posttraumatic stress disorder (PTSD) apply to older children and adolescents. With the introduction of a new, developmentally sensitive set of criteria for very young children (age 6 years and younger) in Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), this raises new questions about the validity of the criteria for older children and adolescents. The current study investigated how diagnostic changes in DSM-5 impact diagnosis rates in 7-18-year olds.

METHODS

PTSD, impairment, and comorbid psychopathology were assessed in 135 trauma-exposed, treatment-seeking participants. Children (ages 7-12) were examined separately from adolescents (ages 13-18) to assess for potential developmental differences.

RESULTS

A significantly higher proportion of 7-12-year-old children met criteria for DSM-5 diagnosis (53%) compared to Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) (37%). However, among 13-18-year-old adolescents, the proportions diagnosed with DSM-5 (73%) and DSM-IV (74%) did not differ. Participants who met criteria for DSM-5 only (17%) did not differ from those diagnosed with DSM-IV in terms impairment or comorbidity. Using the newly accepted age 6 years and younger criteria resulted in a significantly higher proportion of 7-12-year-old (but not 13-18-year olds) children meeting criteria compared to DSM-IV or DSM-5. However, these children showed less impairment and comorbidity than those diagnosed with DSM-IV.

CONCLUSION

These findings suggest that DSM-5 criteria may be more developmentally sensitive than DSM-IV criteria, and may lead to higher prevalence rates of PTSD for 7-12-year-old children, but not for adolescents. Using the very young children criteria for 7-12-year-old children may further increase prevalence, but capture children with less severe psychopathology.

Examining the factor structure and etiology of prosociality

Prosociality is one construct included in the developmental propensity model proposed by Lahey and Waldman (2003, 2005) to explain the development of conduct problems in childhood and adolescence. Findings from previous literature on 2 facets of prosociality, dispositional sympathy and respect for rules, suggest that both may have genetic and nonshared environmental influences, but only the latter may have shared environmental influence. The goal of the current article was to explore the structure of the prosociality disposition from a measurement perspective as well as to examine the etiology of this construct. The sample consisted of 686 twin pairs ages 7 to 13. Parents rated their children's prosociality using the Child and Adolescent Dispositions Scale. The factor structure of the prosociality scale was examined using confirmatory factor analysis to compare a 1-factor model with a 2-factor model. Twin analyses were used to examine the proportion of variance associated with genetic and environmental effects on the latent factor(s) from the best fitting model. Results of the current study suggest that prosociality is a disposition that can be conceptualized as 2 related factors rather than a unitary dimension. These 2 factors map onto the subscales of the prosociality dimension (dispositional sympathy and respect for rules). Both factors had significant genetic and nonshared environmental influences, but only respect for rules had significant shared environmental influences. Examining the dispositional sympathy and respect for rules facets of prosociality separately allowed for the discovery that shared environmental factors may have more impact on respect for rules than sympathy.

Examining transactional influences between reading achievement and antisocially-behaving friends

The association between poorer academic outcomes and having antisocial friends is reliably demonstrated yet not well understood. Genetically sensitive designs uniquely allow for measuring genetic vulnerabilities and/or environmental risk in the association of antisocial friend behavior and poor school achievement, allowing for a better understanding of the nature of the association. This study included 233 pairs of twins from the Florida Twin Project on Reading. First, the role of antisocial friends as an environmental moderator of reading comprehension was examined. Antisocial friends significantly moderated the nonshared environmental variance in reading comprehension, with increased variation at lower levels of association with antisocial friends, with niche-picking indicated. Second, the role of reading comprehension as an environmental moderator of antisocial friends was examined. Reading comprehension significantly moderated the nonshared environmental variance in associating with antisocial friends, with increased variance at lower levels of reading comprehension and indication that common genetic influences contributed to higher reading achievement and better-behaved friends. In total, these results suggested reciprocal influences between reading achievement and antisocially-behaving friends. The impact of antisocial friends appeared to be limited in the extent to which they can undermine reading achievement, and high reading achievement appeared to support less association with antisocial friends.

Examining the etiological associations among higher-order temperament dimensions

A multivariate independent pathway model was used to examine the shared and unique genetic and environmental influences of Positive Affect (PA), Negative Affect (NA), and effortful control (EC) in a sample of 686 twin pairs (M age = 10.07, SD = 1.74). There were common genetic influences and nonshared environmental influences shared across all three temperament dimensions and shared environmental influences in common to NA and EC. There were also significant independent genetic influences unique to PA and NA and significant independent shared environmental influences unique to PA. This study demonstrates that there are genetic and environmental influences that affect the covariance among temperament dimensions as well as unique genetic and environmental influences that influence the dimensions independently.

Negative affect shares genetic and environmental influences with symptoms of childhood internalizing and externalizing disorders

The co-occurrence of internalizing and externalizing disorders suggests that they may have common underlying vulnerability factors. Research has shown that negative affect is moderately positively correlated with both internalizing and externalizing disorders in children. The present study is the first to provide an examination of negative affect in relation to a wide spectrum of childhood internalizing and externalizing problems using a biometric model. This study extends prior findings of more narrowly focused associations by using a factor approach including multiple disorders. The sample for this study included families of 691 same-sex 7- to 13-year old twin pairs. A multifactorial independent pathway model was used to examine the genetic and environmental influences underlying the covariation of parent-reported negative affect, internalizing symptoms, and externalizing symptoms. Results of the current study suggest that negative affect shares genetic and environmental influences with both internalizing and externalizing disorders in childhood. These common influences may partially explain their comorbidity. Understanding that negative affect is at least one contributor to the covariation among these disorders may highlight avenues for early risk assessment, intervention, and perhaps prevention.

Common genetic and nonshared environmental factors contribute to the association between socioemotional dispositions and the externalizing factor in children

BACKGROUND

Childhood behavioral disorders including conduct disorder (CD), oppositional defiant disorder (ODD), and attention-deficit/hyperactivity disorder (ADHD) often co-occur. Prior twin research shows that common sets of genetic and environmental factors are associated with these various disorders and they form a latent factor called Externalizing. The developmental propensity model posits that CD develops in part from socioemotional dispositions of prosociality, negative emotionality, and daring; and recent research has supported the expected genetic and environmental associations between these dispositions and CD. This study examined the developmental propensity model in relation to the broader Externalizing factor that represents the covariance among behavior disorders in children.

METHODS

Parents of 686 six- to twelve-year-old twin pairs rated them on symptoms of CD, ADHD, and ODD using the disruptive behavior disorder scale and on prosociality, negative emotionality, and daring using the child and adolescent dispositions scale. A latent factor multivariate Cholesky model was used with each disposition latent factor comprised of respective questionnaire items and the Externalizing factor comprised of symptom dimensions of CD, ADHD inattention, ADHD hyperactivity/impulsivity, and ODD.

RESULTS

Results supported the hypothesis that the socioemotional dispositions and the Externalizing factor have genetic factors in common, but there was not a single genetic factor associated with all of the constructs. As expected, nonshared environment factors were shared by the dispositions and externalizing factor but, again, no single nonshared environmental factor was common to all constructs. A shared environmental factor was associated with both negative emotionality and externalizing.

CONCLUSIONS

The developmental propensity model was supported and appears to extend to the broader externalizing spectrum of childhood disorders. Socioemotional dispositions of prosociality, negative emotionality, and (to a lesser extent) daring may contribute to the covariation among behavioral disorders and perhaps to their comorbid expression through common sets of primarily genetic but also environmental factors.

Do aggression and rule-breaking have different interpersonal correlates? A study of antisocial behavior subtypes, negative affect, and hostile perceptions of others

There is mounting evidence that physical aggression and nonaggressive, rule-breaking delinquency constitute two separable though correlated subtypes of antisocial behavior. Even so, it remains unclear whether these behavioral subtypes have meaningfully different interpersonal correlates, particularly as they are subsumed within the same broad domain of antisocial behavior. To evaluate this, we examined whether hostile perceptions of others (assessed via exposure to a series of neutral unknown faces) were linked to level and type of antisocial behavior aggression vs. rule-breaking, and moreover, whether this association persisted even when also considering the common association with negative affect (as manipulated via written recollection of one's best and worst life experiences). Analyses revealed that aggression, but not rule-breaking, was uniquely tied to hostile perceptions of others. Furthermore, this association persisted over and above the common association of both hostile perceptions and aggression with negative affect (at both trait and state levels). Such results provide additional support for clinically meaningful differences between the behavioral subtypes of aggression and nonaggressive rule-breaking and for the independent role of hostile perceptions in aggressive behavior.

Preliminary evidence that specific candidate genes are associated with adolescent-onset antisocial behavior

Though initially conceptualized as resulting from peer imitation of child-onset or life-course-persistent youth [Moffitt, 1993], there is mounting evidence from twin studies that adolescent-onset or adolescent-limited antisocial behavior may also be genetically influenced. This study sought to provide preliminary molecular genetic evidence in support of these findings. We further evaluated whether genetic associations varied between behavioral subtypes of ASB (i.e., physical aggression and nonaggressive rule-breaking), given that only the latter has been found to characterize adolescent-onset ASB. The sample consisted of 211 undergraduate men of European-American ancestry. Three polymorphisms with theoretical and/or empirical ties to ASB or related traits (i.e., tryptophan hydroxylase-A218C, 5HT(2A) His452Tyr, and the DAT1 variable nucleotide tandem repeat) were genotyped. Analyses revealed that two of the three polymorphisms (i.e., His452Tyr and DAT1) were associated with adolescent ASB. Moreover, these associations appeared to be specific to the nonaggressive, rule-breaking form of ASB, and did not extend to physical aggression, further supporting ties to adolescent ASB in particular. Such results thus constructively replicate earlier findings of genetic influence on adolescent ASB. They also offer preliminary evidence that the genetic processes underlying aggressive and nonaggressive antisocial behavior may be (at least partially) distinct.