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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Permissive Parenting, Deviant Peer Affiliations & Delinquent Behavior in Adolescence: The Moderating Role of Sympathetic Nervous System Reactivity

The present study examined two measures of sympathetic nervous system (SNS) activity as moderators of the indirect path from permissive parenting to deviant peer affiliations to delinquency among a community sample of adolescents. 

Participants included 252 adolescents (M = 15.79 years; 53 % boys; 66 % European American, 34 % African American). A multi-method design was employed to address the research questions. Two indicators of SNS reactivity, skin conductance level reactivity (SCLR) and cardiac pre-ejection period reactivity (PEPR) were examined. SNS activity was measured during a baseline period and a problem-solving task (star-tracing); reactivity was computed as the difference between the task and baseline periods. Adolescents reported on permissive parenting, deviant peer affiliations, externalizing behaviors, and substance use (alcohol, marijuana). 

Analyses revealed indirect effects between permissive parenting and delinquency via affiliation with deviant peers. Additionally, links between permissive parenting to affiliation with deviant peers and affiliation with deviant peers to delinquency was moderated by SNS reactivity. Less SNS reactivity (less PEPR and/or less SCLR) were risk factors for externalizing problems and alcohol use. 

Findings highlight the moderating role of SNS reactivity in parenting and peer pathways that may contribute to adolescent delinquency and point to possibilities of targeted interventions for vulnerable youth.

Purchase full article at:   http://goo.gl/N5s4CK

By:    Hinnant JB1, Erath SA2, Tu KM2, El-Sheikh M2.

• 1Department of Human Development and Family Studies, Auburn University, 203 Spidle Hall, Auburn, AL, 36849, USA. jbhinnant@auburn.edu.
• 2Department of Human Development and Family Studies, Auburn University, 203 Spidle Hall, Auburn, AL, 36849, USA. 

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Delinquency, Depression, and Psychosis among Adolescents in Foster Care: What Holds Three Heads Together?

Child psychopathology research has traditionally distinguished between internalizing and externalizing disorders, with the former treated with interventions that focus on alleviating negative internal states, and the latter with interventions that reward prosocial behavior and attempt to extinguish negative behavior. Not all disorders fall neatly into these categories, of course. Psychosis could be seen as an externalizing disorder (e.g., patients who become violent when hearing threatening voices) or an internalizing disorder (e.g., believing one is being punished). Multidimensional Treatment Foster Care (MTFC), a comprehensive care system for delinquent girls, appears to have beneficial effects on delinquency, depression, and subthreshold psychotic symptoms over 2 years. Although treatments that have nonspecific benefits might undermine the view that specific disorders have unique causal mechanisms, they are welcome in public health settings, where pure clinical presentations are rare.¹

In the well-done study by Poulton et al.² in this issue of the Journal, 166 girls (13–17 years of age) who had been arrested at least once in the prior 12 months and placed in out-of-home foster care were randomly assigned to MTFC or a group care as usual treatment. Unlike prior “ultra high-risk” studies, the sample was not selected for psychosis symptoms but had historical risk factors (i.e., childhood abuse and neglect) and current diagnoses (i.e., conduct disorder) that are related to psychosis onset. Although the primary purpose of MTFC was to decrease delinquency, the investigators observed secondarily that girls showed decreases in subthreshold psychotic symptoms.

MTFC was implemented in 22 group homes in which foster parents were trained and supervised to implement a reinforcement model. The adolescents attended public school and received concurrent individual therapy. After an average 6-month stay, adolescents returned to parents (or other caregivers) who were trained in effective parenting skills (e.g., consistency, non-harsh discipline) in a family-therapy format. Thus, the program aimed to change the context in which delinquent behaviors developed, first by providing a new home environment and then by modifying the old one. Participants in the group care condition lived in 1 of 35 intensive care settings, where they received at least weekly services and off- or on-grounds schooling.

Over 24 months, adolescents in MTFC had a steeper decline in psychotic symptom severity and roughly half the number of psychotic symptoms compared with adolescents in group care. Psychotic symptoms were measured from the Brief Symptom Inventory (5 items) and the Diagnostic Interview Schedule for Children–IV Psychotic Symptoms scale. The Brief Symptom Inventory included the items “feeling lonely even when you are with people” and “never feeling close to another person.” Psychosis and depression are both characterized by emotional withdrawal, and in this sense, it is not surprising that a treatment that decreased depression also would decrease subthreshold psychosis...

Full article at: http://goo.gl/1EfII3

By: Dr. David J. Miklowitz, 

Dr. David J. Miklowitz, University of California–Los Angeles School of Medicine;

Correspondence to David J Miklowitz, PhD, Division of Child and Adolescent Psychiatry, UCLA Semel Institute Room 58-217, David Geffen School of Medicine, 760 Westwood Plaza, Los Angeles, CA 90024-1759; Email: ude.alcu.tendem@ztiwolkimd

  

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