Psychiatric outcomes of bullying victimization: a study of discordant monozygotic twins.

BACKGROUND: Bullying victimization in childhood is associated with a broad array of serious mental health disturbances, including anxiety, depression, and suicidal ideation and behavior. The key goal of this study was to evaluate whether bullying victimization is a true environmental risk factor for psychiatric disturbance using data from 145 bully-discordant monozygotic (MZ) juvenile twin pairs from the Virginia Twin Study of Adolescent Behavioral Development (VTSABD) and their follow-up into young adulthood. METHOD: Since MZ twins share an identical genotype and familial environment, a higher rate of psychiatric disturbance in a bullied MZ twin compared to their non-bullied MZ co-twin would be evidence of an environmental impact of bullying victimization. Environmental correlations between being bullied and the different psychiatric traits were estimated by fitting structural equation models to the full sample of MZ and DZ twins (N = 2824). Environmental associations were further explored using the longitudinal data on the bullying-discordant MZ twins. RESULTS: Being bullied was associated with a wide range of psychiatric disorders in both children and young adults. The analysis of data on the MZ-discordant twins supports a genuine environmental impact of bullying victimization on childhood social anxiety [odds ratio (OR) 1.7], separation anxiety (OR 1.9), and young adult suicidal ideation (OR 1.3). There was a shared genetic influence on social anxiety and bullying victimization, consistent with social anxiety being both an antecedent and consequence of being bullied. CONCLUSION: Bullying victimization in childhood is a significant environmental trauma and should be included in any mental health assessment of children and young adults.

Siblings of individuals with Smith-Magenis syndrome: an investigation of the correlates of positive and negative behavioural traits.

BACKGROUND: Smith-Magenis syndrome (SMS) is a neurodevelopmental disorder that affects approximately one out of 25,000 births worldwide. To date, no research has been conducted to investigate how having an individual with SMS in a family is a positive or negative influence on siblings. METHODS: To investigate this question we conducted a study involving 79 siblings and 60 parents of individuals with SMS to assess perceptions of how having a sibling with SMS positively and negative influence siblings' behavioural traits. RESULTS: Our findings show that age of siblings of individuals with SMS was associated with a significant increase in positive behavioural traits and a significant decrease in negative behavioural traits. Additionally, siblings who perceive benefits from having a sibling with SMS demonstrate significantly more positive behavioural traits and significantly fewer negative behavioural traits. Parents accurately assess the changes in sibling behavioural traits with age, and parents who perceive their child as having experienced benefits from the sibling relationship report that siblings demonstrate significantly more positive behavioural traits and significantly fewer negative behavioural traits. CONCLUSIONS: Our research shows that although individuals experience difficulties as a result of having a sibling with SMS, overall, siblings tend to fare well and parents appreciate both the positive and negative behavioural effects that result from having a sibling with SMS.

The Virginia Twin Study of Adolescent Behavioral Development. Influences of age, sex, and impairment on rates of disorder.

BACKGROUND: The Virginia Twin Study of Adolescent Behavioral Development is a cohort-longitudinal epidemiological study that uses the genetic twin design to study the development and maintenance of child psychiatric disorders. We determined the rates of DSM-III-R disorders, disorders with impairment, and age, sex, and comorbidity effects. METHODS: Families of 2762 white twins aged 8 to 16 years participated. Twins and their parents were asked systematically about risk factors and current psychiatric symptoms by means of investigator-based psychiatric interviews and questionnaires. The DSM-III-R diagnoses were made for major depressive disorder, separation anxiety, overanxious disorder, simple phobia, social phobia, agoraphobia, oppositional defiant disorder, conduct disorder, and attention deficit hyperactivity disorder. RESULTS: The 3-month point prevalence for any DSM-III-R disorders was 413 per 1000, and that for disorders with associated impairment was 142 per 1000. Emotional disorders with impairment occurred in 89 per 1000, with girls being more commonly affected; behavioral disorders had a prevalence of 71 per 1000, with boys being more frequently affected. The proportion with disorder who also had functional impairment varied across disorders; anxiety and phobic disorders were particularly likely not to be accompanied by impairment. Rates of emotional and behavioral disorders increased over the age range. There was extensive comorbidity among disorders. CONCLUSIONS: The prevalence rates and patterns of findings from this study of twins are consistent with those of other epidemiological studies, supporting previous findings of few differences in rates of psychiatric disorder between twins and singletons. The importance of including measures of functional impairment is evident by its effect on rates of disorder and patterns of comorbidity.

Making sense of informant disagreement for overanxious disorder.

A community sample of 2798 8-17-year-old twins and their parents completed a personal interview about the child's current psychiatric history on two occasions separated by an average of 18 months. Parents also completed a personal interview about their own lifetime psychiatric history at entry to the study. Results indicate that informant agreement for overanxious disorder (OAD) was no better than chance, and most cases of OAD were based on only one informant's ratings. Disagreement about level of OAD symptoms or presence of another disorder (mostly phobias or depression) accounted for most cases of informant disagreement: 60% of cases based only on child interview, 67% of cases based only on maternal interview, and 100% of cases based only on paternal interview. OAD diagnosed only by maternal interview was also distinguished by an association with maternal alcoholism and increasingly discrepant parental reports of marital difficulties. Given the substantial overlap in case assignments for DSM-III-R OAD and DSM-IV GAD, these findings may identify sources of informant disagreement that generalize to juvenile GAD.

Genetic and environmental influences on the temporal association between earlier anxiety and later depression in girls.

BACKGROUND: The purpose of the present study was to investigate the role of genetic and environmental factors in the association between depressive symptoms and symptoms of overanxious disorder, simple phobias, and separation anxiety in 8-13-year-old and 14-17-year-old girls. METHODS: Multivariate genetic models were fitted to child-reported longitudinal symptom data gathered from clinical interview on 415 MZ [corrected] and 194 DZ [corrected] female twin pairs from the Virginia Twin Study of Adolescent Behavioral Development (VTSABD) [corrected]. RESULTS: Model-fitting results suggest there are distinct etiological [corrected] patterns underlying the association between depression and the different anxiety syndromes during the course of development: 1) specific genetic influences on depression after age 14 reflect liability to symptoms of earlier overanxious disorder (OAD) and simple phobias; 2) aspects of the shared environment that influence symptoms of depression before age 14 contribute to symptoms of separation anxiety and simple phobias later in adolescence [corrected]; 3) the shared environmental influence on [corrected] depression in 14+ girls also affects liability to symptoms of concurrent OAD and persistent separation anxiety. CONCLUSIONS: These results suggest that depression before and after age 14 may be etiologically distinct syndromes. Earlier symptoms of OAD and (to a lesser extent phobic symptoms) [corrected] reflect the same genetic risk, and separation anxiety symptoms both before and after age 14 reflect the same environmental risk that influence liability to depressive symptoms expressed in middle to late adolescence.

The family history method: whose psychiatric history is measured?

OBJECTIVE: The family history method, in which an informant is asked about the history of psychiatric illness in relatives, is widely used in psychiatric research. Previous research has examined the influence on family history information of characteristics of the relative. In this report, the authors seek to clarify the impact on family history reporting of the psychiatric history of the informant. METHOD: Both members of female twin pairs from a population-based twin registry were asked about the history of major depression, generalized anxiety disorder, and alcoholism in their mother and father. The authors examined twin pairs discordant for each of the three diagnoses and predicted that the affected twin would report higher rates of the same disorder in her parent than would the unaffected twin. RESULTS: Twins with a history of major depression or generalized anxiety disorder but not twins with alcoholism were significantly more likely to report the same disorder in their parents than were their unaffected co-twins. CONCLUSIONS: For major depression and generalized anxiety disorder, a family history diagnosis appears to reflect the psychiatric history of both the relative and the informant. Caution may be needed in the interpretation of results based on the family history method, although the magnitude of this problem may be attenuated by the use of multiple informants.

The effects of child sexual abuse: Comment on Rind, Tromovitch, and Bauserman (1998).

B. Rind, P. Tromovitch, and R. Bauserman (1998) examined the long-term effects of childhood sexual abuse (CSA) by meta-analyzing studies of college students. The authors reported that effects "were neither pervasive nor typically intense" and that "men reacted much less negatively than women" (p. 22) and recommended value-neutral reconceptualization of the CSA construct. The current analysis revealed numerous problems in that study that minimized CSA-adjustment relations, including use of a healthy sample, an inclusive definition of CSA, failure to correct for statistical attenuation, and misreporting of original data. Rind et al.'s study's main conclusions were not supported by the original data. As such, attempts to use their study to argue that an individual has not been harmed by sexual abuse constitute a serious misapplication of its findings.

Genetic and environmental effects on self-reported depressive symptoms in a general population twin sample.

To determine the etiology of self-reported depressive symptoms and their co-occurrence in the general population, multivariate genetic models were fitted to the responses of 771 female twin pairs (463 MZ, 308 DZ) to a 20-item epidemiological depression inventory (CES-D scale). A model which contained one common genetic factor, one shared environmental factor, and four unique environmental factors provided a useful account of symptom covariation. Under this model, the four non-shared environmental factors explained the largest proportion of variance in response to the CES-D scale, whereas a single common genetic factor explained substantially less of the variation in symptomatology. Consistent with previous findings (Kendler, Heath, Martin, & Eaves, Archives of General Psychiatry 43, 213-221, 1986) shared environmental influences were found to play a relatively minor role in the report of depressive symptoms. These results suggest that while genetic factors do contribute to the covariation among symptoms of depression, it is the largely non-shared environmental factors that account for the co-occurrence of symptoms in the general population.

The application of structural equation modeling to maternal ratings of twins' behavioral and emotional problems.

The application of structural equation modeling to twin data is used to assess the impact of genetic and environmental factors on children's behavioral and emotional functioning. The models are applied to the maternal ratings of behavior of a subsample of 515 monozygotic and 749 dizygotic juvenile twin pairs, ages 8 through 16, obtained through mailed questionnaires as part of the Medical College of Virginia Adolescent Behavioral Development Twin Project. The importance of genetic, shared, and specific environmental factors for explaining variation is reported for both externalizing and internalizing behaviors, as well as significant differences in the causes of variation in externalizing behaviors among young boys and girls. The usefulness of applying structural equation models to data on monozygotic and dizygotic twins and the potential implications for addressing clinically relevant questions regarding the causes of psychopathology are discussed.

Tobacco, alcohol and drug use in eight- to sixteen-year-old twins: the Virginia Twin Study of Adolescent Behavioral Development.

OBJECTIVE: This study reports prevalences of lifetime and current alcohol, tobacco and drug use in adolescents; examines associations between substance use and a number of putative risk factors; and estimates the contribution of genetic, shared and unique environmental influences on substance use. METHOD: Substance use data were collected using the Child and Adolescent Psychiatric Assessment on a population sample of 1,412 male and female monozygotic and dizygotic twin pairs, aged 8 through 16, from the Virginia Twin Study of Adolescent Behavioral Development. RESULTS: Heritabilities were estimated to be 84% and 82% for liability to lifetime and current tobacco use, respectively. For alcohol use the role of genes and environment varied according to the context of reporting. Liability to lifetime alcohol use was estimated to be under environmental control, with 71% of the variation shared by members of a twin pair and 29% unique to individual twins. Lifetime alcohol use without the permission of a parent or guardian and current use of alcohol were predominantly explained by genetic factors (h2 = 72% and 74%). The role of genetic factors increased and that of unique environmental factors decreased with increasing severity of alcohol use. Lifetime use of any drug showed a heritability of 45%, with the shared environment accounting for 47% of the variation. Shared environmental factors explained most of the variation in marijuana use. CONCLUSIONS: Genetic factors explained a significant proportion of the variation in the use of tobacco, alcohol and other drugs. Shared environmental factors contributed significantly to lifetime alcohol use and other drug use.

Genetic and environmental influences on ratings of manifest anxiety by parents and children.

Parental reports and children's self-reports of manifest anxiety were obtained from a community-based sample of twin pairs on two occasions approximately 19 months apart, using the Revised Child Manifest Anxiety Scale (Reynolds & Richmond, 1978). In prior cross-sectional studies, a low degree of agreement between parent and child assessments of anxiety was found. Furthermore, parental reports were found to reflect a higher heritability than children's self-reports (Eaves et al., 1997; Thapar & McGuffin, 1995). The index of temporal stability was moderate for all informants (circa r = .5 to r = .6). To test whether the components contributing to the temporal stability differed between the informants, structural equation models were fitted to the data using the program, Mx: Statistical Modeling (Neale, 1995). The results showed substantial differences in genetic effects according to both gender and informant. For children's self-reports, temporal stability was largely a function of environmental effects, with genetic effects contributing a modest 20%, whereas for parental reports, temporal stability was largely a function of genetic effects. The heritability was higher for parental reports than for boys' self-reports and the genetic covariance between parents and their sons was near zero, indicating that they were reporting on quite different aspects of anxiety. However, for girls, heritability for maternal reports was lower than for self-reports, and the genetic covariance between mother and daughter was about the same as that between mothers and fathers, meaning that they were assessing the same genetically influenced aspect of anxiety. These results highlight the need to focus on gender differences.

Fifteen years of dissociation in maltreated children: where do we go from here?

Controversies have centered on the prevalence of dissociative symptoms and disorders in children and adolescents, recommended treatment approaches, and the potential effects of suggestive interpersonal influences. Convergence among diverse practitioners describing dissociative children and adolescents with similar symptoms and maltreatment histories supports the occurrence of these symptom patterns. Although prevalence information has not been well studied, dissociative symptoms may be found in children from a variety of settings across a continuum of severity. There is not yet agreement on exact treatment protocols, but successful treatment outcomes have been reported. A challenge for future research is to develop assessment protocols that are derived from multiple sources of data, and to incorporate the latest developmental research findings into theory development that addresses psychobiological, family, and cultural factors. The study of dissociation in children and adolescents has the potential to clarify some puzzling child and adolescent presentations and to identify a process by which some children respond and adapt to traumatic environments.

Monoamine oxidase A and childhood adversity as risk factors for conduct disorder in females.

BACKGROUND: Recent studies among males have reported a genotype-environment interaction (GxE) in which low-activity alleles at the monoamine oxidase A (MAOA) locus conferred greater sensitivity to the effects of childhood adversity on risk for conduct disorder (CD). So far, few studies of females have controlled for gene-environment correlation or used females heterozygous for this X-linked gene. METHOD: Logistic regression analysis of a sample of 721 females ages 8-17 years from the longitudinal Virginia Twin Study of Adolescent Behavioral Development (VTSABD) assessed the additive effects of MAOA genotypes on risk for CD, together with the main effect of childhood adversity and parental antisocial personality disorder (ASP), as well as the interaction of MAOA with childhood adversity on risk for CD. RESULTS: A significant main effect of genotype on risk for CD was detected, where low-activity MAOA imparted the greatest risk to CD in girls while controlling for the significant effects of maternal ASP and childhood adversity. Significant GxE with weak effect was detected when environmental exposure was untransformed, indicating a higher sensitivity to childhood adversity in the presence of the high-activity MAOA allele. The interaction was no longer statistically significant after applying a ridit transformation to reflect the sample sizes exposed at each level of childhood adversity. CONCLUSIONS: The main effect of MAOA on risk for CD in females, its absence in males and directional difference of interaction is suggestive of genotype-sex interaction. As the effect of GxE on risk for CD was weak, its inclusion is not justified.

The development of pronoun usage in the psychotic child.

Twenty-three psychotic children ranging in age from 5 to 16 were interviewed in half-hour play sessions. The play session comprised three activities designed to elicit statements using the pronouns I, you, and he to express the concepts of possession, action, and description. It was hypothesized that psychotic children would use the third-person pronoun he more readily than the first-person pronoun I (Hypothesis I), and that possession, action, and description statements would develop in an orderly sequence as predicted by Bosch (1962/1970) (Hypothesis II). Hypothesis I was not confirmed: Some of the least advanced psychotic children used the pronoun I, and only the most advanced children used you and he. Hypothesis II was confirmed: the least advanced children used pronouns correctly in statements expressing the concept of possession, whereas the most advanced children had mastered all three contexts of pronoun use. These results have implications for language therapy, and they are concordant with the language theories of Piaget and Werner and Kaplan.

Dissociative symptomatology in children and adolescents as displayed on psychological testing.

The purpose of this study was to investigate psychological testing features of children and adolescents with dissociative disorder diagnoses to provide diagnostic information that might facilitate early intervention. The psychological testing protocols of 30 children diagnosed with dissociative disorders were compared with the testing protocols of 30 consecutive admissions to the Sheppard Pratt Hospital who did not receive a dissociative identity disorder (DID; formerly termed multiple personality disorder) or dissociative disorder not otherwise specified (DDNOS) diagnosis. A rater, blind to the diagnosis, scored these protocols for the presence or absence of behavioral and testing response variables hypothesized to discriminate between the dissociative patients and the mixed group of other diagnoses. Behavioral features significantly more common in the dissociative group included forgetting, staring, unusual motor behaviors, dramatic fluctuations, fearful and angry reactions to stimuli, physical complaints during testing, and expressions of internal conflict. Significant indications of dissociation in the test responses included images of multiplicity, malevolent religiosity, dissociative coping, depersonalized imagery, emotional confusion, extreme dichotomization, images of mutilation and torture, and magical transformation. A combination of these behavioral and response variables was able to select 93% of the dissociative sample. These results add support to the discriminant validity of DID and DDNOS as diagnostic categories in childhood and provide clinical information that may be useful for early diagnosis of traumatized children with dissociative pathology.

Analysing the contributions of genes and parent-child interaction to childhood behavioural and emotional problems: a model for the children of twins.

BACKGROUND: Despite the demonstrable influence of both genes and the family environment on children's behavioural and emotional development, the mechanisms by which these factors are transmitted from parents to their children are not known. Numerous aspects of the family have long been associated with behavioural and emotional problems in children; it is not clear, however, whether these family variables represent genuine environmental risks or secondary consequences of the underlying genetic liability shared between parents and their children. METHOD: In this study we present a model for analysing the non-genetic contributions of family background to risk for childhood and adolescent depression and conduct disturbance using simulated data on adult MZ and DZ twins, their spouses and children. RESULTS: The twin offspring design provides substantial power to detect remarkably small non-genetic effects on parent-offspring resemblance against the background of genetic transmission. As presented, the model is able to resolve the direction of transmission from both parent to child (passive genotype environment correlation) and child to parent (evocative genotype environment correlation). CONCLUSIONS: Unlike many other genetic studies, a study of twins and their children can sort out which putative family environmental risk factors do actually have a significant environmental impact on the child and which ones only appear to do so because they are associated with genetic mediation.

The Rorschach test for predicting suicide among depressed adolescent inpatients.

With the decreasing length of psychiatric hospitalizations, identification of test indicators of suicide risk becomes critically important. This Rorschach study was designed to model a clinical decision-making scenario concerning adolescent suicide risk. Using Psychiatric Evaluation Form (PEF) scores, we selected a sample of 25 severely depressed and suicidal adolescents; 26 severely depressed, not suicidal adolescents; and 28 not suicidal, not depressed adolescent inpatients at The Sheppard and Enoch Pratt Hospital. A Rorschach Index using the Exner (1986) Comprehensive System for scoring was developed to predict group membership. Four of six of the features on this index selected 64% of suicidal subjects. This constellation included traditional affective variables (vista responses, color-shading blends, color dominated responses, and morbid content) as well as measures of cognitive distortion (inaccurately perceived human movement responses [M-] and special scores). We discuss the implications of these findings for the diagnosis and treatment of the suicidal adolescent.

Patterns of thought disorder on psychological testing. Implications for adolescent psychopathology.

One-hundred thirty-eight hospitalized adolescents exhibiting a broad range of psychopathology were divided into four groups based on the presence or absence of significant thought disorder on the Wechsler IQ (using Johnston and Holzman's Thought Disorder Index) and the Rorschach (using Exner's Schizophrenia Index). All subjects in the four IQ/Rorschach cross-classified groups (group A, low disordered IQ/low disordered Rorschach; group B, low disordered IQ/high disordered Rorschach; group C, high disordered IQ/high disordered Rorschach; group D, high disordered IQ/low disordered Rorschach) were rated as well on clinical symptomatology (using the Psychiatric Evaluation Form, a scale developed by Spitzer and Endicott). A multivariate analysis of variance comparing the means of the Psychiatric Evaluation Form variables for the four groups yielded significant interactions and significant main effects. The results portrayed a symptomatic picture of depression and acting out in group A, borderline-like traits in group B, psychosis in group C, and interpersonal difficulty in group D. These results are interpreted as support for the value of comparative measures of thought disorder in clinical evaluation. Further research to investigate the heretofore undescribed group D is recommended.

Genetic effects on the variation and covariation of attention deficit-hyperactivity disorder (ADHD) and oppositional-defiant disorder/conduct disorder (Odd/CD) symptomatologies across informant and occasion of measurement.

BACKGROUND: Previous studies have shown that the presence of conduct disorder may contribute to the persistence of attention deficit-hyperactivity disorder (ADHD) symptomatology into adolescence; however, the aetiological relationship between the two phenotypes remains undetermined. Furthermore, studies utilizing multiple informants have indicated that teacher ratings of these phenotypes are more valid than maternal reports. METHODS: The genetic structure underlying the persistence of ADHD and oppositional-defiant disorder/conduct disorder (ODD/CD) symptomatologies as rated by mothers and teachers at two occasions of measurement was investigated on a sample of 494 male and 603 female same sex adolescent twin pairs participating in the Virginia Twin Study of Adolescent Behavioral Development (VTSABD). RESULTS: Using structural modelling techniques, one common genetic factor was shown to govern the covariation between the phenotypes across informants and occasion of measurement with additional genetic factors specific to ODD/CD symptomatology and persistence of symptomatology at reassessment. Genetic structures underlying the phenotypes were, to some extent, informant dependent. CONCLUSIONS: The findings indicate that it is unlikely that the co-morbidity between ADHD and ODD/CD is due to environmental influences that are independent of ADHD. Rather it is likely to be due to a shared genetic liability either operating directly, or indirectly through gene-environment correlations or interactions. The covariation between phenotypes across informants and time is governed by a common set of genes, but it seems that ODD/CD is also influenced by additional genetic factors. Developmentally, different forms of genetic liability control ADHD in males and inattention in females.