Childhood externalizing, internalizing and comorbid problems: distinguishing young adults who think about suicide from those who attempt suicide.

BACKGROUND: While childhood externalizing, internalizing and comorbid problems have been associated with suicidal risk, little is known about their specific associations with suicidal ideation and attempts. We examined associations between childhood externalizing, internalizing and comorbid problems and suicidal ideation (without attempts) and attempts by early adulthood, in males and females. METHOD: Participants were from the Quebec Longitudinal Study of Kindergarten Children, a population-based study of kindergarteners in Quebec from 1986 to 1988 and followed-up until 2005. We captured the co-development of teacher-rated externalizing and internalizing problems at age 6-12 using multitrajectories. Using the Diagnostic Interview Schedule administered at age 15 and 22, we identified individuals (1) who never experienced suicidal ideation/attempts, (2) experienced suicidal ideation but never attempted suicide and (3) attempted suicide. RESULTS: The identified profiles were no/low problems (45%), externalizing (29%), internalizing (11%) and comorbid problems (13%). After adjusting for socioeconomic and familial characteristics, children with externalizing (OR 2.00, CI 1.39-2.88), internalizing (OR 2.34, CI 1.51-3.64) and comorbid (OR 3.29, CI 2.05-5.29) problems were at higher risk of attempting suicide (v. non-suicidal) by age 22 than those with low/no problems. Females with comorbid problems were at higher risk of attempting suicide than females with one problem. Childhood problems were not associated with suicidal ideation. Externalizing (OR 2.01, CI 1.29-3.12) and comorbid problems (OR 2.28, CI 1.29-4.03) distinguished individuals who attempted suicide from those who thought about suicide without attempting. CONCLUSION: Childhood externalizing problems alone or combined with internalizing problems were associated with suicide attempts, but not ideation (without attempts), suggesting that these problems confer a specific risk for suicide attempts.

The Slut-Shaming Instrument: Preliminary validation, correlates, and links with psychological distress among adolescent girls.

Despite social awareness of the problem of slut-shaming for adolescent girls, no existing measure captures this construct. Using data from a sample of 202 girls from Québec, Canada (ages 14-17; 68% White), preliminary validation is provided for the Slut-Shaming Instrument, a seven-item measure of negative peer experiences related to being perceived as too sexually active, sexualized, or flirtatious. The measure showed strong psychometric properties including good reliability and factor structure, expected associations with daily experiences of slut-related victimization and sexual harassment, and links with number of sexual partners and other forms of peer victimization. Slut-shaming was associated with distress accounting for these other forms of victimization (including sexual harassment), suggesting the pertinence of addressing this type of gender-based victimization.

Trajectory Classes of Externalizing and Internalizing Symptoms to Adolescent Gambling Participation: An Exploratory Study.

Engagement in underage gambling remains a public health concern. Risk factors for the development of gambling behaviours in adolescence include the presence of externalizing and/or internalizing problems. This study aims to better understand the role of co-occurrence between externalizing and internalizing symptoms from childhood to adolescence in adolescent gambling. Participants were drawn from an ongoing longitudinal study of children with and without early conduct problems. Externalizing and internalizing problems were measured annually using teacher and parent reports. Gambling behaviours were measured using self-report when participants were approximately 15 years old. Latent class growth trajectory analyses identified five mental health trajectory classes: (1) a co-occurring trajectory characterized by stable clinical levels of both externalizing and internalizing problems, (2) an externalizing trajectory characterized by stable high clinical levels of externalizing problems, (3) an internalizing trajectory characterized by stable at-risk levels of internalizing problems, (4) an at-risk externalizing trajectory characterized by decreasing levels of externalizing problems, and (5) a non-clinical trajectory. Invariance analyses suggested that this model remained valid in both boys and girls. Logistic regression analyses suggested that youth who belonged in the externalizing trajectory reported a greater likelihood of past-year gambling behaviours when compared to youth who belong in the comorbid trajectory. No other mental health trajectory was significantly associated with adolescent gambling. Stable high externalizing behaviours in development appear to increase one's risk of gambling behaviours in adolescence. Efforts to target these throughout development could help decrease one's future risk of engaging in these behaviours.

An examination of the relationship between conduct problems and depressive symptoms comorbidity and temperament among elementary school children.

Although the comorbidity between conduct problems (CP) and depressive symptoms (DS) is associated with a host of negative outcomes, the factors, such as temperament, that might explain this comorbidity in school-aged boys and girls are poorly understood. This study compared elementary school children presenting co-occurring CP and DS to children with DS only, CP only, and those with low-level symptoms on temperament dimensions, and explored the moderating role of child sex in the associations. Participants are 487 children (M = 8.38 years, SD = 0.92, 52.2% girls) divided into four groups (CP + DS, DS only, CP only, control). Findings suggest that boys with CP and DS presented a lower level of fear than boys with DS and boys from the control group. They also presented higher levels of activity than boys with DS. Girls with CP and DS presented lower levels of fear than girls with DS, lower levels of approach and activity than girls with CP, and higher levels of shyness than girls from the control group. These findings suggest that temperament may discriminate children with comorbid CP and DS from those presenting only CP or DS.

Self and parent-reported sleep problems of adolescents with childhood conduct problems and comorbid psychological problems.

INTRODUCTION: Childhood conduct problems (CP) are characterized by maladaptive externalizing behaviors and are linked with poor sleep. CP are highly comorbid with other psychological problems, including attention deficit/hyperactivity disorder and depression, which are also associated with disturbed sleep. The present study examined if childhood CP and comorbid depressive and/or attentional-hyperactivity problems were prospectively associated with parent and self-reported sleep difficulties in adolescence. METHODS: Participants (N = 744; 53% boys) from an ongoing longitudinal study in Québec, Canada were assessed for CP and comorbidities when they were between 6 and 9 years old. Participants were classified as without CP, CP only, CP and depressive symptoms, CP and attention-hyperactivity problems, or CP, depressive symptoms, and attention-hyperactivity problems. Regressions were conducted to examine the associations between comorbidity groups, parent, and self-reported sleep problems 7 years later (Median age = 15.33 years), controlling for sex, age, family income, primary caregiver education and medication. RESULTS: Adolescents in all CP groups had higher self and parent-reported sleep problems compared to adolescents without histories of CP. Adolescents with histories of CP, depressive symptoms and attention-hyperactivity problems had more sleep problems than all other groups according to self-reports, but not parent-reports. CONCLUSION: Childhood CP was prospectively linked to sleep problems in adolescence, and comorbid conditions exacerbated these problems, according to youth but not parents.

Understanding Youth Perceptions of Neighborhood Disorder: The Role of Conduct Problems.

While research addresses neighborhood disorder as leading to conduct problems, the role of individual-level differences in shaping adolescent perceptions of neighborhood has been overlooked. Data on youth, over-selected for childhood conduct problems (N = 744, 58% childhood conduct problems, 47% girls), were used to examine the link between conduct problems (time 1: Mean age = 12.23) and perceived neighborhood disorder (time 3: M = 14.30). The mediating role of delinquent friends, peer victimization, depressive symptoms, and observer-rated neighborhood disorder (time 2: M = 13.23) were also tested. Conduct problems were associated with higher levels of perceived neighborhood disorder, via delinquent peers and peer victimization. These findings offer new insight into the consequences of perceived neighborhood disorder for health and wellbeing.

Exploring childhood temperament as a moderator of the association between adolescent sexual minority status and internalizing and externalizing behavior problems.

INTRODUCTION: Sexual minority youth experience worse mental health compared to their heterosexual peers, reflecting the consequences of sexual minority-based stigma. Previous research has focused on contextual variation to understand variability within this vulnerability. Childhood temperament factors such as negative affect, effortful control and surgency/extraversion are important for understanding differential susceptibility to environmental stressors. The objective of the current study was to understand how childhood temperament factors, measured prior to the most difficult developmental period for sexual minority youth, moderated the association between sexual minority status and internalizing and externalizing behavior problems. METHODS: Youth reporting same-sex attraction in an ongoing longitudinal project on the development of conduct problems in Quebec, Canada were matched with heterosexual peers, for an analytic sample of 280 youth (62% girls). Structural equation models were used to examine (1) the association between youth-reported same-sex attraction (ages 13-16) and parent and youth-reported internalizing and externalizing problems a year later at ages 14-17, and (2) the moderating role of temperament (ages 6-9) in this association between sexual minority status and internalizing and externalizing problems. RESULTS: Same-sex attraction was associated with higher levels of youth-reported internalizing and externalizing behavior problems. Surgency/extraversion moderated the association between sexual minority status and youth-reported internalizing and externalizing problems. CONCLUSIONS: These findings suggest that temperament linked to individual visibility may be important for understanding variation in self-reported mental health among sexual minority youth, and supports the use of developmental constructs like temperament to better understand vulnerability to psychosocial difficulties within this population.

Clinical Utility of the Limited Prosocial Emotions Specifier in the Childhood-Onset Subtype of Conduct Disorder.

OBJECTIVE: Clinicians may specify the diagnosis of conduct disorder (CD) as "with limited prosocial emotions" (LPE). This specifier is thought to identify youths with particularly severe and stable symptomatology. However, few studies have examined the clinical usefulness of the LPE specifier among children with childhood-onset CD. The current study examines whether the LPE specifier distinguishes children with particularly severe and persistent symptoms among those with childhood-onset CD. The study also aims to test whether the LPE specifier aids in identifying children with subclinical CD whose conduct problems are at risk of increasing. METHOD: Two hundred sixty-four children showing at least one CD symptom before age 10 were divided based on the presence of CD and the specifier. Children with and without the specifier were compared on number of CD symptoms (assessed at study inception) and trajectory of conduct problems (assessed over 4 years). The analyses controlled for oppositional defiant and attention deficit hyperactivity symptomatology. RESULTS: Compared with children with CD but without LPE, children with CD and the LPE specifier did not differ on likelihood of endorsing most symptoms nor on total numbers of symptoms. Moreover, they did not show a more stable pattern of conduct problems across the 4 years. Children with subclinical CD with and without the LPE specifier were also similar in terms of their symptoms, severity, and evolution of their problems. CONCLUSIONS: Among youths with childhood-onset CD, the specifier appears to offer limited value in identifying those with particularly severe and stable CD symptomatology.

Variations in Gambling Disorder Symptomatology Across Sexual Identity Among College Student-Athletes.

Gambling disorder has serious negative consequences for individual health and wellbeing, while being more prevalent among college student-athletes compared to the general college population. While previous research reports that sexual minority (i.e., gay, lesbian and bisexual) populations have higher rates of addictive behaviors such as alcohol and drug abuse, no previous research has explored risk for gambling disorder symptomatology by sexual identity status. The aim of the current study is to identify differences in the severity of gambling disorder symptomatology between sexual minority and heterosexual student-athletes. A stratified random sample of 19,299 National Collegiate Athletic Association college student-athletes participated in an anonymous survey assessing gambling disorder symptomatology. Student-athletes completed measures assessing their past 12-month problem gambling as measured by the DSM-5 diagnostic criteria for gambling disorder and provided information on their sexual identity. Gay and bisexual men had disordered gambling scores 3.42 times higher than heterosexual men (p < .01), when adjusting for race/ethnicity, and years in college. Gay/lesbian and bisexual women reported disordered gambling scores 2.57 higher than heterosexual women (p < .01) when adjusting for race/ethnicity and years in college. This is the first study to compare the prevalence of gambling disorder symptomatology across sexual identity status. The higher number of gambling disorder symptoms observed among sexual minorities in the current study underlines the need for more research on this topic, and supports the exploration of intervention efforts designed to better address problem gambling among sexual minority communities.

Trajectories of Verbal and Physical Peer Victimization Among Children with Comorbid Oppositional Defiant Problems, Conduct Problems and Hyperactive-Attention Problems.

The high levels of comorbidity between oppositional/conduct problems and hyperactivity/attention problems underscore the need for assessing how vulnerability for peer victimization is shaped by overlap among these behavior problems. Children (mean age 8.39, SD = 0.93) participating in a longitudinal study of the development of conduct problems (N = 744; 348 girls) in Quebec, Canada, were evaluated by their teachers regarding experiences of peer verbal and physical victimization every year for 6 years. Parent and teacher ratings of clinically significant oppositional/conduct problems, and hyperactivity/attention problems, as well as cormorbid opposition defiant/conduct problems and hyperactivity/attention problems were regressed onto trajectories of verbal and physical victimization. While behavior problems (both alone and together) were associated with higher levels of verbal and physical victimization, some variation was observed across rater and type of victimization. Ultimately, these findings suggest the importance of adapting programming for reducing victimization to children with oppositional and conduct problems.

Predicting Depression and Anxiety from Oppositional Defiant Disorder Symptoms in Elementary School-Age Girls and Boys with Conduct Problems.

This study investigated the relationship between the three DSM-5 categories of oppositional defiant disorder (ODD) symptoms (irritable mood, defiant behavior, vindictive behavior) and anxiety/depression in girls and boys with conduct problems (CP) while controlling for comorbid child psychopathology at baseline. Data were drawn from an ongoing longitudinal study of 6- to 9-year-old French-Canadian children (N = 276; 40.8 % girls) receiving special educational services for CP at school and followed for 2 years. Using linear regression analysis, the results showed that irritable mood symptoms predicted a higher level of depression and anxiety in girls and boys 2 years later, whereas the behavioral symptoms of ODD (e.g., defiant, vindictive symptoms) were linked to lower depression scores. The contribution of ODD symptoms to these predictions, while statistically significant, remained modest. The usefulness of ODD irritable symptoms as a marker for identifying girls and boys with CP who are more vulnerable to developing internalizing problems is discussed.

Precocious Initiation into Smoking, Alcohol Use, and Gambling among Children with Conduct Problems.

OBJECTIVE: Adolescent participation in risky and addictive behaviours, such as smoking, substance use, and gambling has the potential to lead to many serious problems. The presence of conduct problems (CPs) and early initiation into risky and addictive behaviours have been independently shown to be associated with adolescent and young adult smoking, drinking, and gambling. Nevertheless, the relation between early initiation into risky and addictive behaviours and CPs remains to be explored among pre-adolescents. Our study aims to examine the prospective relation between CPs in early primary school and pre-adolescent initiation into smoking, alcohol use, and gambling. METHOD: Our study used data from participants in an ongoing prospective, longitudinal study at the Université de Sherbrooke to examine cigarette, alcohol, and gambling initiation among primary school-aged boys and girls with CPs. Children were recruited between the ages of 6 and 9 years from several low socioeconomic status public schools in diverse geographical regions of Quebec. Initiation into cigarettes, alcohol, and gambling was measured 1 year later. RESULTS: Children with CPs were found to be at greater risk for early initiation into smoking, alcohol, and gambling. These effects remained even once other known risk factors, such as poor parental supervision and child effortful control, were controlled for. CONCLUSIONS: These results suggest that CPs present in early elementary school can predict early initiation in to potentially addictive behaviours among boys and girls. Implications for targeted preventive intervention are discussed.

Longitudinal associations between conduct problems and depressive symptoms among girls and boys with early conduct problems.

Youth with conduct problems (CP) may experience high rates of depressive symptoms (DS). However, little is known about the direction of the longitudinal associations between CP and DS in this specific population. Although girls with CP appear at greater risk than boys for presenting comorbid depression, empirical research on gender differences in these associations is even sparser. The current study used autoregressive latent trajectory models to compare four perspectives with hypotheses regarding the longitudinal associations between CP and DS, while taking into account the evolution of both problems. We also examined gender differences in the longitudinal associations. A total of 345 children (40.6 % female) presenting with a high level of CP in early elementary school (mean age at study inception = 8.52; SD = .94) were evaluated annually over a four-year period (5 measurement time points). The results revealed that CP and DS were quite stable over time. Moreover, CP and DS showed strong covariation at each measurement time point, but only one significant positive cross-lagged association between the two processes, indicating that higher levels of DS at time 3 were associated with higher levels of CP 1 year later. No differences were observed in the longitudinal associations between CP and DS in boys and girls. Given the comorbidity and stability of CP and DS, these findings suggest that DS should be systematically evaluated among children with early clinically significant CP, and treatment plans should include interventions aimed at both CP and DS among children who present with both types of problems.

Which Diagnostic Criteria are Most Useful in Discriminating Between Social Gamblers and Individuals with Gambling Problems? An Examination of DSM-IV and DSM-5 Criteria.

The current study sought to identify which diagnostic criteria for gambling disorder have the greatest ability to differentiate between social and problem gamblers. This study was conducted on a sample of male and female college student athletes across the U.S. (n = 8674). Classification and regression tree analysis represents an appropriate technique when addressing the question of an item's diagnostic value, as it sequentially selects variables to isolate sets of observations with similar outcomes. The current results suggest that the item related to preoccupation ("Have there been periods in the past year where you spent a lot of time thinking about gambling?") was the DSM-5 item best able to differentiate between male and female social and problem gamblers in this sample. When considering only the nine criteria retained in the DSM-5, three criteria were identified as key for distinguishing between social and disordered gamblers among men, and one criterion was identified for distinguishing between groups of women. In addition, these results do not support the notion that the illegal acts criterion has a particularly low base rate and found that it can be an important indicator of disordered gambling in a college-aged sample.

Theory of Planned Behavior in School-Based Adolescent Problem Gambling Prevention: A Conceptual Framework.

Given its serious implications for psychological and socio-emotional health, the prevention of problem gambling among adolescents is increasingly acknowledged as an area requiring attention. The theory of planned behavior (TPB) is a well-established model of behavior change that has been studied in the development and evaluation of primary preventive interventions aimed at modifying cognitions and behavior. However, the utility of the TPB has yet to be explored as a framework for the development of adolescent problem gambling prevention initiatives. This paper first examines the existing empirical literature addressing the effectiveness of school-based primary prevention programs for adolescent gambling. Given the limitations of existing programs, we then present a conceptual framework for the integration of the TPB in the development of effective problem gambling preventive interventions. The paper describes the TPB, demonstrates how the framework has been applied to gambling behavior, and reviews the strengths and limitations of the model for the design of primary prevention initiatives targeting adolescent risk and addictive behaviors, including adolescent gambling.

Teacher awareness and attitudes regarding adolescent risky behaviours: is adolescent gambling perceived to be a problem?

Despite legislative prohibitions, there is empirical evidence that youth gamble on both regulated and unregulated activities. The current survey was designed to assess teachers' awareness and attitudes regarding adolescent gambling and other high-risk behaviours. Three-hundred and ninety teachers from Ontario and Quebec, with experience teaching students aged 12-18, completed an online survey. Results suggest that teachers are aware of the fact that youth gamble. Furthermore, they recognized the addictive nature of gambling and their subsequent consequences. Despite overestimating the proportion of youth experiencing gambling problems, gambling was viewed as being the least serious of issues affecting youth, with drug use and school violence topping the list. Almost half of respondents indicated that gambling in school can constitute a good learning activity. In regards to prevention, all other risky behaviours and academic problems were perceived as issues needing greater attention than gambling. These results, which are largely consistent with findings from a previous study examining parental perceptions of adolescent risky behaviours, suggest a need for greater awareness and teacher education.

Predicting gambling problems from gambling outcome expectancies in college student-athletes.

While previous research has suggested the potential importance of gambling outcome expectancies in determining gambling behaviour among adolescents, the predictive ability of gambling outcome expectancies has not yet been clearly delineated for college-aged youth. The current study aims to explore the relationships between gender and outcome expectancies in the prediction of gambling severity among college student-athletes. Data from the National Collegiate Athletic Association (NCAA) study assessing gambling behaviours and problems among U.S. college student-athletes were utilized. Complete data was available for 7,517 student-athletes. As expected, male college student-athletes reported more gambling participation as well as greater gambling problems than their female counterparts. Findings showed positive relationships between the outcome expectancies of financial gain, and negative emotional impacts and gambling problems. That is, those who endorsed more items on the outcome expectancy scales for financial gain and negative emotional impacts also tended to endorse more gambling-related problems. Findings also showed a negative relationship between outcome expectancies of fun and enjoyment, and gambling problems over and above the variance accounted for by gender. Those with gambling problems were less likely to have the expectation that gambling would be fun than those without gambling problems. Despite NCAA efforts to curb gambling activity, the results suggest that college student-athletes are at risk for over-involvement in gambling. Therefore, it is important to explore gambling outcome expectancies within this group since the motivations and reasons for gambling might be able to inform treatment initiatives.

Association of childhood externalizing, internalizing, comorbid problems with criminal convictions by early adulthood.

Childhood externalizing problems have been linked with adult criminality. However, little is known about criminal outcomes among children with comorbid externalizing and internalizing problems. We examined the associations between profiles of behavioral problems during childhood (i.e., externalizing, internalizing, and comorbid) and criminality by early adulthood. Participants were N = 3017 children from the population-based Quebec Longitudinal Study of Kindergarten Children followed up from age 6-25. Multitrajectory modeling of teacher-rated externalizing and internalizing problems from age 6-12 years identified four distinct profiles: no/low, externalizing, internalizing, and comorbid problems. Juvenile (age 13-17) and adult (age 18-25) criminal convictions were extracted from official records. Compared to children in the no/low profile, those in the externalizing and comorbid profiles were at higher risk of having a criminal conviction, while no association was found for children in the internalizing profile. Children with comorbid externalizing and internalizing problems were most at risk of having a criminal conviction by adulthood, with a significantly higher risk when compared to children with externalizing or internalizing problems only. Similar results were found when violent and non-violent crimes were investigated separately. Specific interventions targeting early comorbid behavioral problems could reduce long-term criminality.

Problem gambling in adolescents: an examination of the pathways model.

This research tests the applicability of the Integrated Pathways Model for gambling to adolescent problem gamblers, utilizing a cross-sectional design and self-report questionnaires. Although the overall sample consisted of 1,133 adolescents (Quebec: n = 994, 87.7 %; Ontario: n = 139, 12.3 %: Male = 558, 49.5 %; Female = 569, 50.5 %), only problem gamblers were retained in testing the model (N = 109). Personality and clinical features were assessed using the Millon Adolescent Clinical Inventory, attention deficit hyperactivity (ADHD) using the Conners-Wells' Adolescent Self-Report Scale, and the DSM-IV-MR-J and Gambling Activities Questionnaire to determine gambling severity and reasons for gambling. Latent class analysis concluded 5 classes, yet still provided preliminary support for three distinct subgroups similar to those proposed by the Pathways Model, adding a depression only subtype, and a subtype of problem gamblers experiencing both internalizing and externalizing disorders. ADHD symptoms were found to be common to 4 of the 5 classes.

Longitudinal relationships between conduct problems, depressive symptoms, and school dropout.

School dropout can be an ongoing process of academic failure and disengagement starting as early as elementary school. Given the multitude of factors involved and the importance of early identification of vulnerabilities, this study examined whether (a) initial levels of conduct problems and depressive symptoms predicted school dropout, (b) the rate of change in conduct problems and depressive symptoms predicted dropout, (c) the interaction between trajectories of conduct problems and depressive symptoms affected the likelihood of dropout, and (d) whether there were sex differences in these associations. Using a dataset of 364 children ages 6-9 (T1) years who had displayed conduct problems, mean trajectories of conduct problems and depressive symptoms over 6 years were drawn using parallel process latent growth curve modeling. Results showed that both the initial levels of and rate of change in conduct problems predicted dropout, whereas trajectories of depressive symptoms did not. The interaction between trajectories of conduct problems and depressive symptoms was non-significant and sex differences were not observed. These results suggest that, for boys and girls presenting early conduct problems, although a higher initial levels of conduct problems increases the risk of school dropout, a larger decrease in these problems over time may reduce this likelihood. Recognizing and treating conduct problems consistently may be crucial in reducing the risk of dropout in children with early-onset issues.