Clinical characteristics of alcohol combined with other substance use disorders in an American Indian community sample

HIGHLIGHTS

• Multi-substance use disorder was more prevalent than single use disorder.
• Alcohol was the most common drug followed by stimulants and cannabis.
• Multi-substance use disorder was more severe and had greater co-morbidity.

BACKGROUND:

Alcohol and other substance use disorders (SUD) pose major problems of morbidity and mortality in some American Indian communities, but little is known about the clinical characteristics, risk factors, and consequences of combined alcohol and other substance use disorders (multi-substance use disorder, MSUD) in those communities.

METHODS:

Using the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA), in a community sample of 876 American Indians, the clinical characteristics of lifetime DSM-5 moderate or severe alcohol use disorder alone (AUD alone) (n=146) and MSUD (defined as alcohol and ≥1 other SUD) (n=284) were evaluated and compared to 347 participants with no lifetime SUD (no SUD).

RESULTS:

The majority (57%) of participants with a SUD had multi-substance use disorder and 94% of those were with AUD. Stimulants (cocaine and/or amphetamine) and/or cannabis were the most common other SUDs. Participants with AUD alone were more likely to be male and have an earlier age of first alcohol intoxication than those with no SUD. Those with MSUD were more likely to have dropped out of high school, have antisocial personality disorder (ASPD) or conduct disorder (CD), have earlier ages of first alcohol intoxication and first use of cannabis and stimulants, an earlier age of onset of AUD, and more of several AUD symptoms than those with AUD alone, but the same temporal course and time to remission of AUD.

CONCLUSIONS:

MSUD is prevalent in this sample, is associated with multiple comorbidities and denotes a more severe alcohol syndrome than AUD alone.

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By:  Gilder DA1, Stouffer GM1, Lau P1, Ehlers CL2.

• 1Molecular and Cellular Neuroscience Department, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, USA.
• 2Molecular and Cellular Neuroscience Department, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, USA. Electronic address: cindye@scripps.edu.
• Drug Alcohol Depend. 2016 Apr 1;161:222-9. doi: 10.1016/j.drugalcdep.2016.02.006. Epub 2016 Feb 8. 

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Impaired Executive Function in 14- to 16-Year-Old Boys with Conduct Disorder Is Related to Recidivism

BACKGROUND:

Several studies have suggested a relationship between cognitive impairment and recidivism, but most have adopted a retrospective design.

AIM:

The aim of this study was to test for any relationship between impaired executive function in adolescents with conduct disorder and subsequent recidivism up to 3 years later.

METHOD:

In this prospective cohort study, 221 male adolescents with conduct disorder, admitted to a juvenile justice assessment centre for the first time, were interviewed about their offence, age, onset of delinquency and family history. They completed the Wisconsin Card Sorting Test (Keio version) (KWCST) and the Iowa gambling task. Scores were compared between those who subsequently re-offended and those who did not.

RESULTS:

Seventy-six (34%) participants re-offended. There was no direct difference between groups in executive function, but there were age differences both in executive function and in recidivism. Multivariate logistic regression analysis indicated that the variables, which were independently associated with recidivism, were younger age, change in the person who brought up the child, and fewer (≤4) categories achieved on the KWCST. Recidivists were about twice as likely as single offenders to have achieved four categories or less on the KWCST (odds ratio 2.2, 95% confidence interval 1.1-4.4).

CONCLUSIONS:

Impaired executive function appears to predispose to recidivism among young first-time male offenders with conduct disorder. Our findings also suggest that further precise assessments of environmental stress on developing neurocognitive function could clarify the background of antisocial behaviour.

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By:  Miura H1,2, Fuchigami Y1.

• 1Nagoya Juvenile Classification Home, Nagoya, Aichi, Japan.
• 2Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan. 
• Crim Behav Ment Health. 2016 Feb 10. doi: 10.1002/cbm.1993. 

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Comparison of Family Power Structure and Identity Style Between Delinquent and Non-Delinquent Juveniles - Iran

Background:

Adolescence denotes a time in which youth begins to experience dangerous behaviors like substance use and delinquency.

Objectives:

In this study, we investigated the family power structure and identity style in delinquent and non-delinquent juveniles residing in Tehran, Iran.

Materials and Methods:

To accomplish the goal of the study, 80 adolescent delinquents of the correction and rehabilitation centers aged between 15 and 18 years were selected with convenience sampling method and 80 students of secondary school age between 15 and 18 years in Tehran, Iran in 2012. They answered the instrument of family power structure (Saidian, 2004) and identity style (ISI-6G: White et al. 1998). The obtained data were analyzed using the independent t-test, chi-square test, and Levene’s test.

Results:

The findings indicated a significant difference between delinquent and non-delinquent juveniles with regard to family power structure, its subscales (P < 0.001), and identity style (P < 0.001). Moreover, the informational identity style was associated with lower levels of delinquency. In addition, a diffuse-evident identity style was related to the delinquency.

Conclusions:

These results emphasize that the inappropriate decision-making process pattern in a family has a significant effect on deviant behavior and identity style in adolescents. So, family power structure can be considered in therapeutic interventions (prevention and treatment) for adolescent delinquency.

...Results revealed that there are significant differences between delinquent and non-delinquent juveniles with regard to the family power structure. The results of the current study are comparable to previous findings which have been done in this field. For example, Wentzel and Feldman (24) compared the global ratings of family cohesion and family power structure to adolescent behaviors and found that adolescents who rated their parents as egalitarian were most likely to report low levels of depression and high levels of social self-concept and self-restraint. Beavers (25) showed that the power structure of the delinquent juvenile family is anarchy because only one of their parents controls the whole power (26). This power of family structure leads to the unknown boundary of their family system (27). In a detailed review, the previous study shows that child behavior problems are related to lack of parental support and control (28), an imbalanced parent-child relationship (29,30), lack of cohesion and structure in the family (31-34), and poor quality of communication between parents and children (14, 35). Similarly, the previous study has concluded that the families of violent adolescents have high rates of abuse, neglect, aversive behavior and parental deviance and low rates of positive communication (7). Further study showed that adolescents originating from two-parent households are less inclined to engage in delinquent behavior than those originating from one-parent families (36, 37).

These findings suggest that family structure is a significant predictor of most self-reported delinquent behaviors. Based on family systematic perception, family structure was related to breaking and entering, cannabis use, fighting, theft, vandalism, and weapons possession (38). The results of the current study reveal that identity style has a significant difference between delinquent and non-delinquent juveniles. It also showed that adolescents who utilize a normative identity style (relying on social convention and norms to regulate their behaviors) are nearly identical in both groups. Also the informational identity style associates with lower levels of delinquency and a diffuse-evident identity style relates to the delinquency. The prior research indicated that use of the informational and normative styles was negatively linked to delinquency (39, 40). In other words, an information-oriented style relates to a more adaptive pattern of interpersonal behaviors (41, 42). In addition, endorsement of social norms and conventions with strong social ties are associated with less delinquent behavior (39). Similarly, conscientiousness or constraint as reflected in careful, information-based planning is associated with a lower occurrence of delinquent behaviors (43). However, a burgeoning body of literature indicates that individuals with a diffuse-avoidant style engage in self-serving problem behaviors and maladaptive patterns of interpersonal behaviors such as conduct disorders, delinquency, illegal drug use, and alcohol abuse (19, 41, 42, 44-46), while impulsiveness and low levels of self-control are associated with conduct problems and disorders (47). Philips and Pittman indicated that adolescents employing a diffuse-avoidant style differed significantly from those employing information or normative styles in terms of self-esteem, hopelessness, optimism/efficacy, and delinquent attitudes. Diffuse-avoidant participants were less optimistic, had lower self-esteem, expressed greater hopelessness, and had higher delinquent attitude scores than participants using either a normative or an informational style (47)...

Full article at:   http://goo.gl/aQK2Lv

By:  Anahita Khodabakhshi Koolaee,1,* Masoumeh Rahmatizadeh,2 Hossein Shaghelanilor,2 and Lesley Pocock3

¹Department of Counseling and Psychology, Institute of Higher Education of Khatam, Tehran, IR Iran

²Department of Psychology, University of Science and Culture, Tehran, IR Iran

³Medical Educator, Medical Publisher, Medi and World International, Melbourne, Australia

^*Corresponding author: Anahita Khodabakhshi Koolaee, Department of Counseling and Psychology, Institute of Higher Education of Khatam, Tehran, IR Iran. Tel: +98-9122342717, Fax: +98-2188922449, E-mail: moc.oohay@ihshkabadohk_anna

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Assessing Reactive and Proactive Aggression in Detained Adolescents Outside of a Research Context

The Reactive Proactive Aggression Questionnaire (RPQ) is a self-report tool for assessing reactive aggression (RA) and proactive aggression (PA). This study contributes to the literature by testing the psychometric properties of the RPQ across detained boys from various ethnicities whilst using data that were gathered during clinical assessments. The factorial, convergent, and criterion validity, and the internal consistency of the RPQ scores received strong support in the total sample and across four ethnicity groups. Also, three groups of boys were identified, with the group including boys with high levels of both RA and PA including the most severe boys in terms of anger, delinquency, alcohol/drug use, and psychopathic traits, and having the highest prevalence rate of conduct disorder and substance use disorder. Together, these findings suggest that the RPQ may hold promise for assessing RA and PA in detained boys, even when confidentiality and anonymity of the information is not guaranteed.

… Results from confirmatory factor analyses (CFA) supported the two-factor structure over the one-factor structure of the RPQ, and showed that a significant distinction can be made between reactive aggression and proactive aggression in detained adolescent males. Specifically, all model fit indices were indicative of an acceptable or good model fit in the total sample and in youths from various ethnicities, except for the χ²/df ratio for the total sample. However, with increasing sample size and a constant number of degrees of freedom, the χ² value increases, and theχ²/df ratio, therefore, may suggest to reject a plausible model [38]. Because the χ²/df ratio was below the cut-off value in three subgroups and because all the other fit indices supported the two-factor model of the RPQ, this model can be considered to be acceptable in the total sample as well.

Our findings also provide support for the convergent validity of the RPQ scores. At the zero-order level, RPQ total, RA and PA scores, were positively related to other indices of aggressive behavior and features of anger-irritability. Also, after controlling for the PA score, only the RA score remained significantly related to anger and irritability, but was no longer related to aggressive CD symptoms. These results support the view that reactive, but not proactive aggression, is often accompanied with anger and a loss of impulse control [4,5]. Although some of the aggressive CD symptoms can occur as an uncontrolled response to frustration or anger (e.g., forcing someone into sexual activity, initiating fights, using a weapon that can cause serious physical harm), the RA score was never significantly related to aggressive CD symptoms after controlling for the PA score. Yet, after controlling for the RA score, the PA score remained significantly related to aggressive CD symptoms (Table 3) in the total sample and Dutch and Moroccan boys. This suggests that the aggression displayed by detained youths with a CD diagnosis is likely to be premeditated and planned, a notion that is supported by the finding that only the PA score was positively related to aggressive conduct disorder (Tables 4, ​,55).

The results also supported the criterion validity of the RPQ score in detained male youths. As hypothesized, only the RA score was positively related to depressive feelings, anxiety, and suicide ideation after controlling for the other RPQ scale score. Although there were no clear expectations about the relationship between the RPQ and social problems, the RA score was positively associated with this outcome in the total sample and some ethnicity groups. Overall, our findings are in accordance with recent work, including studies that scrutinized relations with suicide risk, social problems and peer rejection [41, 42], and support the claim that reactive aggression is an indicator of overall poor psychosocial adjustment [13]. However, the results do not support the suggestion that reactive aggression is primarily related to low prosocial behavior, and that proactive aggression has little or no association with prosocial behavior independent of reactive aggression [13]. In contrast, the present study showed that only the PA score was significantly negatively related to prosocial behavior after controlling for the RA score. Given that few studies addressed the relationship between self-reported reactive and proactive aggression and prosocial behavior, future studies are warranted. The finding that a higher PA score was associated with a lower level of prosocial behavior, nevertheless, corresponds with the finding that only PA was positively related to self-reported offenses (Tables 4, ​,55)…

Full article at:   http://goo.gl/O5mjWE

By:  Olivier F. Colins

Department of Child and Adolescent Psychiatry, Curium-Leiden University Medical Center, Endegeesterstraatweg 27, 2342 AK Oegstgeest, The Netherlands

Academic Workplace Forensic Care for Youth (Academische Werkplaats Forensische Zorg voor Jeugd), Zutphen, The Netherlands

Olivier F. Colins, Email: ln.muiruc@sniloc.o.

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Writing Abilities Longitudinally Predict Academic Outcomes of Adolescents with ADHD

Students with attention-deficit/hyperactivity disorder (ADHD) often experience a host of negative academic outcomes, and deficits in reading and mathematics abilities contribute to these academic impairments. Students with ADHD may also have difficulties with written expression, but there has been minimal research in this area and it is not clear whether written expression abilities uniquely contribute to the academic functioning of students with ADHD. 

The current study included a sample of 104 middle school students diagnosed with ADHD (Grades 6-8). Participants were followed longitudinally to evaluate whether written expression abilities at baseline predicted student grade point average (GPA) and parent ratings of academic impairment 18 months later, after controlling for reading ability and additional relevant covariates. 

Written expression abilities longitudinally predicted both academic outcomes above and beyond ADHD and oppositional defiant disorder symptoms, medication use, reading ability, and baseline values of GPA and parent-rated academic impairment. 

Follow-up analyses revealed that no single aspect of written expression was demonstrably more impactful on academic outcomes than the others, suggesting that writing as an entire process should be the focus of intervention

Purchase full article at:   http://goo.gl/MEzqso

By:  Molitor SJ, Langberg JM, Bourchtein E, Eddy LD, Dvorsky MR, Evans SW.

Sch Psychol Q. 2016 Jan 18.

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The Predictive Utility of Conduct Disorder Symptoms in Preschool Children: A 3-Year Follow-Up Study

Conduct disorder (CD) symptoms often emerge during the preschool years, but it is not clear whether they predict later symptoms. 

The present study examined whether age 3 CD symptoms predict age 6 CD symptoms beyond oppositional defiant disorder (ODD) and attention-deficit/hyperactivity disorder—hyperactive/impulsive (ADHD HI) symptoms. Participants were 216 preschool children (M_Age = 44.19 months), including an externalizing sample (n = 161) and a comparison group (n = 55). Parents were administered a diagnostic interview when children were 3 years old and again three years later. 

The externalizing sample exhibited more CD symptoms than the comparison sample. In the externalizing sample, initial CD symptoms predicted later CD symptoms above and beyond ODD and ADHD HI symptoms; this relation was stronger for boys than girls. Stealing, property destruction, and fighting independently predicted later CD symptoms. CD symptoms also predicted subsequent ADHD HI symptoms and predicted ODD symptoms at level that approached significance. 

Results support the predictive validity of CD symptoms in preschool.

...First, CD symptoms significantly discriminated 3-year-old children with and without externalizing problems, and were quite rare among children without problems, suggesting these behaviors are not developmentally normative. Second, consistent with recent findings that early CD diagnosis predicts later diagnosis [13,16], CD symptoms at age 3 predicted CD symptoms three years later, even above baseline ODD and ADHD HI symptoms. This result further suggests that early CD symptoms may be of clinical concern and not merely a normative developmental phase. Third, results suggested that three symptoms were particularly useful in predicting later CD symptoms: breaking things, stealing, and fighting. These results are consistent with Loeber et al.’s finding that fighting is an important symptom in school-age children [38]. Fourth, CD symptoms appear to have utility not only in predicting future CD, but also in predicting subsequent ADHD HI and ODD symptoms. In contrast, children with more early symptoms of ADHD HI and ODD were not more likely to show later symptoms of CD. Finally, consistent with previous research [13,16], early CD symptoms more strongly predicted later problems for boys than for girls, though the relationship between early and later CD symptoms was also significant for girls.

The results of this study did not support existing theory and research on older children that suggest that either ODD or ADHD are developmental precursors to CD [3,23–24]. The findings in relation to ADHD HI are in line with a number of studies with younger [42] and older children [28] that suggest that hyperactivity may not predict future CD/aggression once early symptoms are controlled. In fact, for boys in this study, there was an unexpected negative relation between ADHD HI symptoms at age 3 and CD symptoms at age 6 once initial ODD and CD symptoms were controlled. We are not sure how to account for this surprising finding, but we propose two possibilities. First, this could be an instance of suppressor variables. That is, because initial ODD and CD symptoms were controlled for in this analysis, our finding estimates the relation between ADHD HI symptoms and later CD symptoms in boys with equivalent levels of ODD and CD. When early problem behaviors exist, perhaps it is better if these are due to impulsivity that might be somewhat outgrown, than to other, perhaps even more entrenched causes. Second, given the unexpected nature of this finding, it could simply be a Type I error. This study also does not support the notion that ODD may be a developmental precursor to CD, at least during the preschool years. Co-occurrences among these problem types may be the result of common influences, such as coercive parenting cycles or biological risk factors, rather than heterotypic continuity. If in fact ODD and CD develop in parallel, rather than sequentially, it is not clear that CD should preclude a diagnosis of ODD, as is currently specified in DSM-5 [43]. More research is needed to better understand the developmental progression of ADHD HI, ODD, and CD symptoms... 

Full article at:  http://goo.gl/wIei8A

By:  Benjamin Rolon-Arroyo, David H. Arnold, and Elizabeth A. Harvey

University of Massachusetts Amherst

Rolon-Arroyo, B. Department of Psychology (http://www.psych.umass.edu/), University of Massachusetts, 135 Hicks Way, Amherst, 01003, USA ude.ssamu.hcysp@ranolorb

Arnold, D. H. Department of Psychology, University of Massachusetts, 135 Hicks Way, Amherst, 01003, USA ude.ssamu.hcysp@dlonrad

Harvey, E. A. Department of Psychology, University of Massachusetts, 135 Hicks Way, Amherst, 01003, USA ude.ssamu.hcysp@yevrahe

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Different Brain Responses During Empathy in Autism Spectrum Disorders vs Conduct Disorder & Callous-Unemotional Traits

BACKGROUND:

Deficits in empathy are reported in autism spectrum disorders (ASD) and also underlie antisocial behavior of individuals with conduct disorder and callous-unemotional traits (CD/CU+). Many studies suggest that individuals with ASD are typically impaired in cognitive aspects of empathy, and individuals with CD/CU+ typically in affective aspects. In the current study, we compared the neural correlates of cognitive and affective aspects of empathy between youth with ASD and youth with CD/CU+.

METHODS:

Functional magnetic resonance imaging (fMRI) was used to assess boys with ASD (N = 23), boys with CD/CU+ (N = 23), and typically developing (TD) boys (N = 33), aged 15-19 years. Angry and fearful faces were presented and participants were asked to either infer the emotional state from the face (other-task; emotion recognition) or to judge their own emotional response to the face (self-task; emotional resonance).

RESULTS:

During emotion recognition, boys with ASD showed reduced responses compared to the other groups in the ventromedial prefrontal cortex (vmPFC). During emotional resonance, the CD/CU+ and ASD groups showed reduced amygdala responses compared to the TD controls, boys with ASD showed reduced responses in bilateral hippocampus, and the CD/CU+ boys showed reduced responses in the inferior frontal gyrus (IFG) and anterior insula (AI).

CONCLUSION:

Results suggest differential abnormal brain responses associated with specific aspects of empathic functioning in ASD and CD/CU+. Decreased amygdala responses in ASD and CD/CU+ might point to impaired emotion processing in both disorders, whereas reduced vmPFC responses suggest problems in processing cognitive aspects of empathy in ASD. Reduced IFG/AI responses, finally, suggest decreased emotional resonance in CD/CU+.

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By:  Klapwijk ET1,2, Aghajani M1,2, Colins OF1,2, Marijnissen GM3, Popma A4,5, van Lang ND1,2, van der Wee NJ2,6, Vermeiren RR1,2,4.

• 1Department of Child and Adolescent Psychiatry, Curium - Leiden University Medical Center, Leiden, The Netherlands.
• 2Leiden Institute for Brain and Cognition (LIBC), Leiden, The Netherlands.
• 3Centrum Autisme Rivierduinen, Leiden, The Netherlands.
• 4Department of Child and Adolescent Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.
• 5Institute of Criminal Law & Criminology, Faculty of Law, Leiden University, Leiden, The Netherlands.
• 6Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands. 

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