Evidence-Based Assessment of DSM-5 Disruptive, Impulse Control, and Conduct Disorders.

The assessment of oppositional defiant disorder, conduct disorder, antisocial personality disorder, and intermittent explosive disorder-the Disruptive, Impulse Control and Conduct Disorders-can be affected by biases in clinical judgment, including overestimating concerns about distinguishing symptoms from normative behavior and stigma associated with diagnosing antisocial behavior. Recent nosological changes call for special attention during assessment to symptom dimensions of limited prosocial emotions and chronic irritability. The present review summarizes best practices for evidence-based assessment of these disorders and discusses tools to identify their symptoms. Despite the focus on disruptive behavior disorders, their high degree of overlap with disruptive mood dysregulation disorder can complicate assessment. Thus, the latter disorder is also included for discussion here. Good practice in the assessment of disruptive behavior disorders involves using several means of information gathering (e.g., clinical interview, standardized rating scales or checklists), ideally via multiple informants (e.g., parent-, teacher-, and self-report). A commitment to providing a full and accurate diagnostic assessment, with careful and attentive reference to diagnostic guidelines, will mitigate concerns regarding biases.

Clinical utility of diagnosing limited prosocial emotions in young children using the Clinical Assessment of Prosocial Emotions (CAPE).

This study evaluated the interrater reliability, convergent and divergent validity, incremental validity, and clinical prognostic utility of the Clinical Assessment of Prosocial Emotions (CAPE; Frick, 2013) for assessing limited prosocial emotions (LPE). Participants were 232 young children (Mage = 3.94 years, SD = 1.46, range = 2-8; 74.6% boys) clinic-referred for conduct problems. We scored the CAPE using binary and dimensional scoring approaches and measured outcomes using parent-report and child laboratory measures. CAPE LPE symptom ratings had good interrater reliability. Children diagnosed with pretreatment LPE had more severe externalizing problems and lower empathy than children without LPE but did not differ in emotion recognition accuracy or anxiety. Dimensional CAPE symptom sum scores were associated with criterion variable scores in expected ways and offered incremental validity beyond scores on the parent-report Inventory of Callous-Unemotional Traits for predicting conduct problem severity, aggression, empathy deficits, and global emotion recognition accuracy. Among children who completed parent management training (n = 44), those diagnosed with LPE ended treatment with more severe aggressive behavior than those without LPE. Overall, children diagnosed with CAPE LPE have severe externalizing problems and achieve reduced benefits from standard parent management training, supporting the need for tailored and intensive interventions to maximize treatment outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The social gradient in adolescent mental health: mediated or moderated by belief in a just world?

PURPOSE: A social gradient in adolescent mental health exists: adolescents with higher socioeconomic status (SES) have fewer mental health problems than their peers with lower SES. Little is known about whether adolescents' societal beliefs play a role in this social gradient. Belief in a just world (BJW) may be a mediator or moderator of the social gradient in adolescent mental health. METHODS: Using data from 848 adolescents (Mage = 17) in the Netherlands, path analyses examined whether two indicators of BJW (general and personal) mediated or moderated the associations between two indicators of SES (family affluence and perceived family wealth), and four indicators of adolescent mental health problems (emotional symptoms, conduct problems, hyperactivity, and peer problems). RESULTS: Adolescents with lower family affluence and lower perceived family wealth reported more emotional symptoms, and the association between perceived family wealth and emotional symptoms was mediated by lower personal and general BJW. Furthermore, higher personal BJW amplified the negative association between SES and peer problems. CONCLUSION: This study suggests BJW may both mediate and amplify the social gradient in adolescent mental health. Adolescents' beliefs about society may be important to include in research aimed at understanding this social gradient.

Resolução de conflitos familiares por adolescentes e defesa do domínio pessoal / Adolescents' family conflict resolution and defense of personal domain / Resolución de conflictos familiares por adolescentes y defensa del dominio personal

Compreender as estratégias de resolução de conflitos utilizadas por adolescentes na relação com seus pais é fundamental para entender como ocorre seu desenvolvimento saudável. Este artigo investigou a resolução de conflitos de adolescentes em situações de confronto entre o seu domínio pessoal e o controle parental. 36 adolescentes com idades entre 15 e 17 anos, divididos igualmente conforme o sexo, responderam a uma entrevista semiestruturada, que continha quatro situações de conflito hipotéticas. Os dados foram submetidos à análise de conteúdo semântica e a testes não paramétricos. Os resultados foram categorizados em sete estratégias: Assunção de culpa, Submissão, Mentira, Hostilidade, Diálogo/Explicação, Negociação e Outra. A forma predominante de resolução utilizada foi o Diálogo/Explicação, considerada como uma forma recorrente de defender o domínio pessoal. Foram encontradas diferenças em relação ao sexo dos participantes e à situação hipotética. Por fim, os resultados são discutidos em termos de grau de autonomia e tipo de defesa do domínio pessoal.(AU)

Understanding the conflict resolution strategies used by adolescents in their relationship with their parents is fundamental to understanding how their healthy development occurs. This article investigated the resolution of conflicts by adolescents in confrontation situations between their personal domain and parental control. A total of 36 adolescents, aged 15 to 17 years, divided equally according to sex, answered a semi-structured interview that contained four hypothetical conflict situations. Data were subjected to semantic content analysis and non-parametric tests. The results were categorized into seven strategies: Assumption of Guilt, Submission, Lie, Hostility, Dialogue/Explanation, Negotiation, and Other. The predominant form of resolution used was Dialogue/Explanation, considered a recurrent form of defense of the personal domain. Differences were found depending on the participants' gender and the hypothetical situation. Finally, the results are discussed regarding the degree of autonomy and type of defense of the personal domain.(AU)

Enterarse de las estrategias de resolución de conflictos que los adolescentes utilizan en la relación con sus padres es fundamental para comprender cómo ocurre el desarrollo saludable de los adolescentes. A partir de una entrevista semiestructurada, presentamos cuatro situaciones hipotéticas de conflicto que fueron analizadas y respondidas por 36 adolescentes de entre 15 y 17 años, divididos según el género. Los datos se sometieron a un análisis de contenido semántico y a pruebas no paramétricas. Los resultados se categorizaron en siete estrategias de resolución de conflictos: Asunción de culpa, Sumisión, Mentira, Hostilidad, Diálogo/Explicación, Negociación y Otros. La forma de resolución más utilizada fue Diálogo/Explicación, y esta categoría fue una forma de defensa del dominio personal. Asimismo, se encontraron diferencias en función del género de los participantes y conforme la situación hipotética. Los resultados se discuten en términos de grado de autonomía y tipo de defensa del dominio personal.(AU)

Trends in the prevalence of conduct disorder from 1990 to 2019: Findings from the Global Burden of Disease Study 2019.

Conduct disorder is one of the least widely recognized and studied psychiatric disorders. This study aimed to comprehensively analyze the burden of conduct disorder at the global, regional, and national levels based on the Global Burden of Disease (GBD) 2019 estimates. Globally, the age-standardized prevalence rates (ASPRs) of conduct disorder slightly increased from 1990 to 2019 with an estimated annual percentage change (EAPC) at 0.147. Males had a higher burden than females, but females had a greater increment in ASPRs than males over time. In 2019, the highest ASPR of conduct disorder was observed in Western Europe, followed by Eastern Europe, with the lowest one found in East Asia, then South Asia. However, the most significant increment in ASPRs was observed in high-income North America, followed by East Asia, and South Asia. The EAPCs at the national level were negatively associated with the ASPRs in 1990. The burden of conduct disorder continues to increase globally, especially in high-income North America, East Asia, and South Asia, and should have more attention focused on it.

Assessment of the quality of routine ambulatory healthcare for common disorders in children and adolescents in Germany: study protocol for a retrospective medical record review (QualiPäd).

INTRODUCTION: The quality of healthcare in childhood and adolescence is of key importance, in order to foster a healthy development and to avoid chronic health problems. Yet, data for Germany regarding the quality of healthcare for this patient group are lacking. The QualiPäd research project aims to estimate the quality of outpatient healthcare for children and adolescents in Germany, focusing on common psychiatric and physical disorders. METHODS AND ANALYSIS: Quality indicators for seven common physical and mental childhood and adolescent clinical conditions (attention deficit/hyperactivity disorder, asthma, atopic dermatitis, depression, otitis media, conduct disorder/oppositional defiant disorder, tonsillitis) will be developed and ratified by experts, using the RAND/UCLA Appropriateness Method.Initially, 1400 medical records of children and adolescents with one of the aforementioned clinical conditions will then be randomly drawn from 40 outpatient practices in the German federal state of Hessen. The records will then be assessed regarding their adherence to the respective quality indicators. Based on this, the percentage of appropriate and inappropriate (eg, wasteful) healthcare of all clinical conditions (primary endpoint) will be estimated. Additionally, possible factors influencing the quality of care (eg, patient characteristics, type of condition, type of practice) will be identified using generalised estimation equation models. ETHICS AND DISSEMINATION: This study will show for which of the studied clinical conditions and/or patients improvement of quality of care is necessary within the German health system. Also, the quality indicators designed for the study can afterwards be implemented in regular care and thus enable regular reporting of the outpatient care of this target group. The authors plan to disseminate their findings through international, peer-reviewed scientific publications, and through presentations at national and international paediatric and child psychiatric conferences. TRIAL REGISTRATION NUMBER: DRKS00022408.

Assessment of the association between non-suicidal self-injury disorder and suicidal behaviour disorder in females with conduct disorder.

BACKGROUND: Non-suicidal self-injury (NSSI) and aggression have been demonstrated to serve as risk factors of suicidal behaviours (SB). Non-suicidal self-injury disorder (NSSID) and Suicidal Behaviour Disorder (SBD) are among new diagnostic categories for further studies in the DSM-5 classification. METHODS: We recruited 196 girls (aged 15.5 ± 1.2 years) diagnosed with conduct disorder (CD). All of them were assessed with respect of non-suicidal self-injury acts, suicidal attempts, psychopathology, self-esteem and general functioning. RESULTS: Age of NSSI onset was significantly lower compared to age of first suicidal attempt. SBD was present in 50.0% of patients with NSSID and the prevalence of NSSID in individuals with SBD was estimated at 52.2%. A diagnosis of NSSID, with at least 8 days of engagement in self-injuries during the preceding year, significantly predicted the risk of SBD. This effect appeared to be independent of depressive symptomatology. LIMITATIONS: Our results cannot be generalized over the whole population of individuals diagnosed with CD because of a lack of male patients, as well as individuals with the most severe and mildest forms of CD. Causal inferences cannot be established due to a cross-sectional study design. CONCLUSIONS: The NSSID with at least 8 days of engagement in self-injuries during the preceding year serves as a predictor of SBD independently of the effects of depressive symptoms. Longitudinal studies are required to confirm our findings.

Preempting the Development of Antisocial Behavior and Psychopathic Traits.

Antisocial behavior and psychopathic traits are subject to complex patterns of inheritance, gene--environment interactive effects, and powerful environmental influences. Yet genetic factors are important in the etiology of antisocial behavior and psychopathic traits, and identifying youth with an elevated genetic risk may lead to improved interventions and preventive efforts. Additionally, research revealing the importance of gene--environment interactions in the development of antisocial behavior and psychopathic traits should be harnessed to promote more rehabilitative, developmentally appropriate policies to benefit youth in the juvenile justice and social welfare systems.

The Validity of the Personality Assessment Inventory-Adolescent in Assessing Callous-Unemotional Traits in At-Risk Adolescents.

This study examines the validity of the Personality Assessment Inventory-Adolescent (PAI-A; Morey) in assessing callous-unemotional (CU) traits within two independent samples of at-risk adolescents from a residential intervention program. The study tests the extent to which CU traits are represented within PAI-A scales with respect to empirically- or theoretically-related indicators, such as antisociality, aggression, low warmth, low social connectedness, and subdued internalizing psychopathology. The PAI-A substantive scales statistically accounted for an average of 55.0% of the variance in total scores on the Inventory of Callous-Unemotional Traits (ICU; Frick) across samples. Broadly, PAI-A substantive scales evinced theoretically-consistent relations with CU traits. Consistent with expectations, CU traits were broadly related to PAI-A-assessed constructs of antisocial features, aggression, low warmth and social disconnection, but not to subdued internalizing symptoms. Moreover, some of the PAI-A clinical, treatment consideration, and interpersonal scales or subscales demonstrated differential relations across the traits. Implications for assessment of CU traits using the PAI framework are discussed. Overall, this research adds to the literature on CU traits in broadband personality assessment and provides a foundation for future research on CU traits using the PAI-A.

The Direct and Indirect Associations between Childhood Socioeconomic Disadvantage and Adolescent Gun Violence.

We examined whether childhood socioeconomic disadvantage was associated with adolescent gun violence and whether early symptoms of conduct disorder and/or exposure to delinquent peers accounted for the linkage. Participants were 503 predominately Black and White boys who were recruited in 1st grade from Pittsburgh public schools. Multi-informant assessments were conducted regularly from approximately ages 7 to 20. A latent socioeconomic disadvantage factor was estimated with census-tract and parent-reported data when boys were about age 7½. Latent growth curve models assessed parent/teacher-reported conduct problems and youth-reported peer delinquency from about ages 7½ to 10. The outcome was youth-reported engagement in gun violence by about age 20. We also controlled for race. Analyses examined whether the association between childhood socioeconomic disadvantage and adolescent gun violence was mediated through early conduct problems and/or increased exposure to delinquent peers. Childhood socioeconomic disadvantage was associated with adolescent gun violence, and some of this effect was mediated through peer delinquency and conduct problems. Specifically, childhood socioeconomic disadvantage was associated with greater affiliation with delinquent peers in early childhood, and early peer delinquency promoted a greater increase in conduct problems across childhood, and these conduct problems, in turn, led to an increased risk for adolescent gun violence. In summary, this study found that early socioeconomic disadvantage was directly and indirectly related to adolescent gun violence. Results suggest that interventions that aim to reduce conduct problems and deviant peer group affiliation in childhood might be important windows of opportunity for reducing gun violence in impoverished neighborhoods.

Community-Based Prevalence of Externalizing and Internalizing Disorders among School-Aged Children and Adolescents in Four Geographically Dispersed School Districts in the United States.

The Project to Learn About Youth-Mental Health (PLAY-MH; 2014-2018) is a school-based, two-stage study designed to estimate the prevalence of selected mental disorders among K-12 students in four U.S.-based sites (Colorado, Florida, Ohio, and South Carolina). In Stage 1, teachers completed validated screeners to determine student risk status for externalizing or internalizing problems or tics; the percentage of students identified as being at high risk ranged from 17.8% to 34.4%. In Stage 2, parents completed a structured diagnostic interview to determine whether their child met criteria for fourteen externalizing or internalizing disorders; weighted prevalence estimates of meeting criteria for any disorder were similar in three sites (14.8%-17.8%) and higher in Ohio (33.3%). PLAY-MH produced point-in-time estimates of mental disorders in K-12 students, which may be used to supplement estimates from other modes of mental disorder surveillance and inform mental health screening and healthcare and educational services.

Longitudinal pathways of engagement, social interaction skills, hyperactivity and conduct problems in preschool children.

Preschool children's engagement/social interaction skills can be seen as aspects of positive functioning, and also act as protective aspects of functioning. On the other hand, hyperactivity/conduct problems are risk aspects that negatively affect children's everyday functioning. Few studies have investigated such orchestrated effects on mental health in young children over time. The aims of the study are first, to identify homogeneous groups of children having similar pathways in mental health between three time points. Second, to examine how children move between time points in relation to risk and protective factors. Alongitudinal study over 3 years, including 197 Swedish preschool children was used. Questionnaire data collected from preschool teachers. Statistical analysis using person-oriented methods with repeated cluster analyses. Children high in engagement/social skills and low in conduct problems continue to function well. Children with low engagement/social skills exhibiting both hyperactivity and conduct problems continue to have problems. Children with mixed patterns of protective factors and risk factors showed mixed outcomes. The stability of children's pathways was quite high if they exhibited many positive protective factors but also if they exhibited many risk factors. Children exhibiting a mixed pattern of protective and risk factors moved between clusters in a less predictable way. That stability in mental health was related to the simultaneous occurrence of either many protective factors or many risk factors supports the notion of orchestrated effects. The results indicate that early interventions need to have a dual focus, including both interventions aimed at enhancing child engagement and interventions focused on decreasing behavior problems.

A Case of Clinical Scholarship.

A 32-year-old child and adolescent psychiatry resident with a history of presenting an abstract at a local psychiatric conference during residency and fourth authorship on an immunotherapy paper from a summer internship during medical school presents with a new-onset desire to write a case report. She has just come off her consultation liaison rotation, during which she consulted on a 12-year-old boy with attention-deficit/hyperactivity disorder, oppositional defiant disorder, disruptive mood dysregulation disorder, and low depressive state hospitalized for pseudoseizures, a new-onset inability to walk, and aggressive outbursts. He had a negative magnetic resonance imaging scan, negative computed tomography scan, negative laboratory test results, and an unremarkable lumbar puncture. Based on an equivocal electroencephalogram, a neurology resident decided to prescribe a mood stabilizer, obtained it himself from the pharmacy, and administered it to the patient intravenously, only then realizing that it was six times the intended loading dose. Before anybody could stop him, the resident erased all documentation about the medication and fled the city. Nevertheless, that afternoon, before the error and fraud were caught by a pharmacist and before the child and his family were notified, the child's symptoms appeared to resolve and the child walked comfortably for the first time in months. The child and adolescent psychiatry resident is tentatively titling the case report, "Resolution of Conversion Disorder With a Megadose of Unknown Mood Stabilizer."

Comparing the potential causal influence of two indicators of early alcohol use on later alcohol use disorder symptoms.

Age of first drink (AFD) has repeatedly been found to be associated with alcohol use disorder (AUD); however, some studies suggest this is a noncausal effect that may be due to childhood risk factors or familial influences. In contrast to indicators of any early alcohol use, such as AFD, indicators of a pattern of repeated drinking may be more likely to be causally associated with later problematic alcohol use. The current study examined AFD and age of onset of regular drinking (ARD; defined as drinking at least once a month for 6 or more months) as quasicausal predictors of lifetime AUD symptoms. Participants were 3,005 adult Australian twins who reported having been regular drinkers in their lifetime. Semistructured interviews were conducted to assess AFD, ARD, AUD, externalizing symptomatology, and other substance use. Personality traits were assessed via questionnaire. Unadjusted and adjusted multilevel discordant twin models were conducted using data from 1,041 complete twin pairs; adjusted models included socioeconomic status, personality, conduct disorder, and early initiation of regular smoking and marijuana use as covariates. Results from fully adjusted models controlling for familial confounds provided evidence for a causal influence of ARD on AUD symptoms, whereby twins with an earlier age of regular drinking than their cotwin had more lifetime AUD symptoms. However, AFD did not significantly predict AUD symptoms after adjusting for confounds. These results suggest that early regular drinking may serve as a causal risk factor for future problems, while early initiation of any alcohol use may indicate genetic liability. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Associations between conduct problems in childhood and adverse outcomes in emerging adulthood: a longitudinal Swedish nationwide twin cohort.

BACKGROUND: We examined whether childhood conduct problems predicted a wide range of adverse outcomes in emerging adulthood and whether the association with internalizing problems remained after adjusting for general comorbidity and externalizing problems. METHODS: Participants were 18,649 twins from the Child and Adolescent Twin Study in Sweden. At age 9/12, parents rated their children on eight conduct problems. Adverse outcomes were retrieved from national registers in emerging adulthood (median follow-up time = 9.2 years), including diagnoses of six psychiatric disorders, prescriptions of antidepressants, suicide attempts, criminality, high school ineligibility, and social welfare recipiency. We estimated risk for the separate outcomes and examined if conduct problems predicted an internalizing factor above and beyond a general comorbidity and an externalizing factor. We used twin analyses to estimate genetic and environmental contributions to these associations. RESULTS: On the average, each additional conduct symptom in childhood was associated with a 32% increased risk of the adverse outcomes in emerging adulthood (mean hazard ratio = 1.32; range = 1.16, 1.56). A latent childhood conduct problems factor predicted the internalizing factor in emerging adulthood (ßboys  = .24, standard error, SE = 0.03; ßgirls  = .17, SE = 0.03), above and beyond its association with the externalizing (ßboys  = 0.21, SE = 0.04; ßgirls  = 0.17, SE = 0.05) and general factors (ßboys  = 0.45, SE = 0.03; ßgirls  = 0.34, SE = 0.04). These associations were differentially influenced by genetic and environmental factors. CONCLUSIONS: It is important to monitor boys and girls with conduct problems not only for future externalizing problems, but also for future internalizing problems. Prevention of specific outcomes, however, might require interventions at different levels.

The Clinical Assessment of Prosocial Emotions (CAPE 1.1): A multi-informant validation study.

Support for the clinical importance of callous and unemotional (CU) traits has grown considerably in recent years, yet tools for the assessment of CU traits in clinical settings have largely been limited to questionnaires. This study examined the validity of the Clinical Assessment of Prosocial Emotions (CAPE 1.1), a newly developed clinician-rating measure of CU traits in children and adolescents. Participants were children aged 3 to 15 years (N = 82; 75% male) who were referred for treatment of conduct problems. Diagnoses of conduct disorder and oppositional defiant disorder were formulated based on semistructured diagnostic interviews prior to treatment. The CAPE 1.1 was scored based on structured interviews administered jointly to mothers and fathers and was validated with questionnaire measures of CU traits and other correlates of CU traits from multiple informants. Evidence of criterion validity was found in significant associations between CAPE 1.1 scores and questionnaire measures of CU traits completed by mothers, fathers, and teachers. Evidence of construct validity was found in significant associations between CAPE 1.1 scores and established correlates of CU traits, including severity of oppositional defiant disorder/conduct disorder symptoms indexed via diagnostic interview with parents, teacher ratings of proactive aggression, and reports of affective empathy by mothers and fathers. These findings provide support for the clinical utility of the CAPE 1.1 and its inclusion as part of a comprehensive assessment of children and adolescents with conduct problems. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Cost-effectiveness analysis of parenting interventions for the prevention of behaviour problems in children.

BACKGROUND: Behavior problems are common among children and place a high disease and financial burden on individuals and society. Parenting interventions are commonly used to prevent such problems, but little is known about their possible longer-term economic benefits. This study modelled the longer-term cost-effectiveness of five parenting interventions delivered in a Swedish context: Comet, Connect, the Incredible Years (IY), COPE, bibliotherapy, and a waitlist control, for the prevention of persistent behavior problems. METHODS: A decision analytic model was developed and used to forecast the cost per averted disability-adjusted life-year (DALY) by each parenting intervention and the waitlist control, for children aged 5-12 years. Age-specific cohorts were modelled until the age of 18. Educational and health care sector costs related to behavior problems were included. Active interventions were compared to the waitlist control as well as to each other. RESULTS: Intervention costs ranged between US$ 14 (bibliotherapy) to US$ 1,300 (IY) per child, with effects of up to 0.23 averted DALYs per child (IY). All parenting interventions were cost-effective at a threshold of US$ 15,000 per DALY in relation to the waitlist control. COPE and bibliotherapy strongly dominated the other options, and an additional US$ 2,629 would have to be invested in COPE to avert one extra DALY, in comparison to bibliotherapy. CONCLUSIONS: Parenting interventions are cost-effective in the longer run in comparison to a waitlist control. Bibliotherapy or COPE are the most efficient options when comparing interventions to one another. Optimal decision for investment should to be based on budget considerations and priority settings.

Affective dysregulation in childhood - optimizing prevention and treatment: protocol of three randomized controlled trials in the ADOPT study.

BACKGROUND: The terms affective dysregulation (AD) and irritability describe transdiagnostic dimensions and are characterized by an excessive reactivity to negative emotional stimuli with an affective (anger) and a behavioral component (aggression). Due to early onset, high prevalence and persistence, as well as developmental comorbidity, AD in childhood is one of the most psychosocially impairing and cost-intensive mental health conditions. AD is especially prevalent in children in the youth welfare service. Despite continuous research, there remains a substantial need for diagnostic approaches and optimization of individualized treatment strategies in order to improve outcomes and reduce the subjective and economic burden. METHODS: The ADOPT (Affective Dysregulation - Optimizing Prevention and Treatment) Consortium integrates internationally established, highly experienced and interdisciplinary research groups. The work program encompasses (a) epidemiology, including prevalence of symptoms and disorders, (b) development and evaluation of screening and assessment tools, (c) stepped care approaches for clinically useful personalized medicine, (d) evaluation of an easily accessible and cost-effective online intervention as indicated prevention (treatment effects, moderation/mediation analysis), and (e) evaluation of an intensive personalized modular outpatient treatment in a cohort of children with AD who live with their parents and in a cohort of children with AD who live in out-of-home care (treatment effects, moderation/mediation analysis). DISCUSSION: The results will lead to significant recommendations for improving treatment within routine clinical care in two cohorts of children with AD and coexisting conditions, especially oppositional-defiant disorder, conduct disorder and disruptive mood dysregulation disorder. TRIAL REGISTRATION: Trial registration ADOPT Online: German Clinical Trials Register (DRKS) DRKS00014963 . Registered 27 June 2018. Trial registration ADOPT Treatment: German Clinical Trials Register (DRKS) DRKS00013317 . Registered 27 September 2018. Trial registration ADOPT Institution: German Clinical Trials Register (DRKS) DRKS00014581 . Registered 04 July 2018.

[Socioeconomic status and health insurance expenditures for children and adolescents with conduct disorder : An analysis of statutory health insurance data]. / Einfluss des sozioökonomischen Status auf Gesundheitskosten für Kinder und Jugendliche mit Störungen des Sozialverhaltens : Eine Analyse von Routinedaten einer gesetzlichen Krankenversicherung.

BACKGROUND: For various psychiatric and somatic disorders, there is evidence of an association between patients' socioeconomic status (SES), healthcare utilisation, and the resulting costs. In the field of child and adolescent psychiatric disorders, studies on this topic are lacking. OBJECTIVES: To exploratively analyse the association of healthcare expenditures for children and adolescents with conduct disorder (including oppositional-defiant disorder) - one of the most prevalent child and adolescent psychiatric disorders - and SES. MATERIALS AND METHODS: The analysis is based on routine data from the German statutory health insurance company AOK Nordost for the calendar year 2011, covering 6461 children and adolescents (age 5-18 years) with an ICD-10 diagnosis of conduct disorder. The insureds' SES was estimated indirectly, based on the social structure of the postcode area, using the German Index of Multiple Deprivation (Mecklenburg-Vorpommern, Brandenburg), and the Berliner Sozialindex I (Berlin), respectively. From the two indices, quintiles were derived. Based on these quintiles, average costs per case for the following cost types were analysed: inpatient healthcare, outpatient healthcare (general practitioners, paediatricians, child and adolescent psychiatrists, child and adolescent psychotherapists), and prescribed medication. RESULTS: There was no significant functional association between SES and healthcare costs for any of the analysed cost types. CONCLUSIONS: In contrast to findings in adults, this study on children and adolescents with conduct disorders did not reveal an association between SES and healthcare costs. Within this group of patients, social inequality does not seem to have a significant influence on healthcare utilisation in Germany.

A risk calculator to predict adult attention-deficit/hyperactivity disorder: generation and external validation in three birth cohorts and one clinical sample.

AIM: Few personalised medicine investigations have been conducted for mental health. We aimed to generate and validate a risk tool that predicts adult attention-deficit/hyperactivity disorder (ADHD). METHODS: Using logistic regression models, we generated a risk tool in a representative population cohort (ALSPAC - UK, 5113 participants, followed from birth to age 17) using childhood clinical and sociodemographic data with internal validation. Predictors included sex, socioeconomic status, single-parent family, ADHD symptoms, comorbid disruptive disorders, childhood maltreatment, ADHD symptoms, depressive symptoms, mother's depression and intelligence quotient. The outcome was defined as a categorical diagnosis of ADHD in young adulthood without requiring age at onset criteria. We also tested Machine Learning approaches for developing the risk models: Random Forest, Stochastic Gradient Boosting and Artificial Neural Network. The risk tool was externally validated in the E-Risk cohort (UK, 2040 participants, birth to age 18), the 1993 Pelotas Birth Cohort (Brazil, 3911 participants, birth to age 18) and the MTA clinical sample (USA, 476 children with ADHD and 241 controls followed for 16 years from a minimum of 8 and a maximum of 26 years old). RESULTS: The overall prevalence of adult ADHD ranged from 8.1 to 12% in the population-based samples, and was 28.6% in the clinical sample. The internal performance of the model in the generating sample was good, with an area under the curve (AUC) for predicting adult ADHD of 0.82 (95% confidence interval (CI) 0.79-0.83). Calibration plots showed good agreement between predicted and observed event frequencies from 0 to 60% probability. In the UK birth cohort test sample, the AUC was 0.75 (95% CI 0.71-0.78). In the Brazilian birth cohort test sample, the AUC was significantly lower -0.57 (95% CI 0.54-0.60). In the clinical trial test sample, the AUC was 0.76 (95% CI 0.73-0.80). The risk model did not predict adult anxiety or major depressive disorder. Machine Learning approaches did not outperform logistic regression models. An open-source and free risk calculator was generated for clinical use and is available online at https://ufrgs.br/prodah/adhd-calculator/. CONCLUSIONS: The risk tool based on childhood characteristics specifically predicts adult ADHD in European and North-American population-based and clinical samples with comparable discrimination to commonly used clinical tools in internal medicine and higher than most previous attempts for mental and neurological disorders. However, its use in middle-income settings requires caution.