Dysfunctional posttraumatic cognitions, posttraumatic stress and depression in children and adolescents exposed to trauma: a network analysis.

BACKGROUND: The latest version of the International Classification of Diseases (ICD-11) proposes a posttraumatic stress disorder (PTSD) diagnosis reduced to its core symptoms within the symptom clusters re-experiencing, avoidance and hyperarousal. Since children and adolescents often show a variety of internalizing and externalizing symptoms in the aftermath of traumatic events, the question arises whether such a conceptualization of the PTSD diagnosis is supported in children and adolescents. Furthermore, although dysfunctional posttraumatic cognitions (PTCs) appear to play an important role in the development and persistence of PTSD in children and adolescents, their function within diagnostic frameworks requires clarification. METHODS: We compiled a large international data set of 2,313 children and adolescents aged 6 to 18 years exposed to trauma and calculated a network model including dysfunctional PTCs, PTSD core symptoms and depression symptoms. Central items and relations between constructs were investigated. RESULTS: The PTSD re-experiencing symptoms strong or overwhelming emotions and strong physical sensations and the depression symptom difficulty concentrating emerged as most central. Items from the same construct were more strongly connected with each other than with items from the other constructs. Dysfunctional PTCs were not more strongly connected to core PTSD symptoms than to depression symptoms. CONCLUSIONS: Our findings provide support that a PTSD diagnosis reduced to its core symptoms could help to disentangle PTSD, depression and dysfunctional PTCs. Using longitudinal data and complementing between-subject with within-subject analyses might provide further insight into the relationship between dysfunctional PTCs, PTSD and depression.

The latent structure of Acute Stress Disorder symptoms in trauma-exposed children and adolescents.

BACKGROUND: The revision of Acute Stress Disorder (ASD) in the DSM-5 (DSM-5, 2013) proposes a cluster-free model of ASD symptoms in both adults and youth. Published evaluations of competing models of ASD clustering in youth have rarely been examined. METHODS: We used Confirmatory Factor Analysis (combined with multigroup invariance tests) to explore the latent structure of ASD symptoms in a trauma-exposed sample of children and young people (N = 594). The DSM-5 structure was compared with the previous DSM-IV conceptualization (4-factor), and two alternative models proposed in the literature (3-factor; 5-factor). Model fit was examined using goodness-of-fit indices. We also established DSM-5 ASD prevalence rates relative to DSM-IV ASD, and the ability of these models to classify children impaired by their symptoms. RESULTS: Based on both the Bayesian Information Criterion, the interfactor correlations and invariance testing, the 3-factor model best accounted for the profile of ASD symptoms. DSM-5 ASD led to slightly higher prevalence rates than DSM-IV ASD and performed similarly to DSM-IV with respect to categorising children impaired by their symptoms. Modifying the DSM-5 ASD algorithm to a 3+ or 4+ symptom requirement was the strongest predictor of impairment. CONCLUSIONS: These findings suggest that a uni-factorial general-distress model is not the optimal model of capturing the latent structure of ASD symptom profiles in youth and that modifying the current DSM-5 9+ symptom algorithm could potentially lead to a more developmentally sensitive conceptualization.

Predictors of Posttraumatic Stress Symptom Trajectories in Parents of Children Exposed to Motor Vehicle Collisions.

OBJECTIVE: Following child trauma, parents are at risk of developing posttraumatic stress disorder (PTSD), either owing to their direct involvement or from hearing of their child's involvement. Despite the potential impact of a parent's development of PTSD on both the parent and child, little is known about what may place a parent at increased risk. METHOD: PTSD symptoms were assessed ≤ 4 weeks, 6 months, and 3 years post-trauma, along with a range of potential risk factors, in a sample of parents of 2-10-year-old children who were involved in a motor vehicle collision. RESULTS AND CONCLUSIONS: Two symptom trajectories were identified: Those parents whose symptoms remained low across all time points and those whose symptoms remained elevated at 6 months post-trauma and declined by 3 years. Subjective threat, thought suppression, and maladaptive cognitions about damage to the child were identified as key predictors of poorer outcomes.

An Update on the Clinical Utility of the Children's Post-Traumatic Cognitions Inventory.

The Children's Post-Traumatic Cognitions Inventory (CPTCI) is a self-report questionnaire that measures maladaptive cognitions in children and young people following exposure to trauma. In this study, the psychometric properties of the CPTCI were examined in further detail with the objective of furthering its utility as a clinical tool. Specifically, we investigated the CPTCI's discriminant validity, test-retest reliability, and the potential for the development of a short form of the measure. Three samples (London, East Anglia, Australia) of children and young people exposed to trauma (N = 535; 7-17 years old) completed the CPTCI and a structured clinical interview to measure posttraumatic stress disorder (PTSD) symptoms between 1 and 6 months following trauma. Test-retest reliability was investigated in a subsample of 203 cases. The results showed that a score in the range of 46 to 48 on the CPTCI was indicative of clinically significant appraisals as determined by the presence of PTSD. The measure also had moderate-to-high test-retest reliability (r = .78) over a 2-month period. The Children's Post-Traumatic Cognitions Inventory-Short Form (CPTCI-S) had excellent internal consistency (α = .92), and moderate-to-high test-retest reliability (r = .78). The examination of construct validity showed the model had an excellent fitting factor structure (Comparative Fit index = 0.95, Tucker-Lewis index = 0.91, Root Mean Square Error of Approximation = .07). A score ranging from 16 to 18 was the best cutoff point on the CPTCI-S, in that it was indicative of clinically significant appraisals as determined by the presence of PTSD. Based on these results, we concluded that the CPTCI is a useful tool to support the practice of clinicians and that the CPTCI-S has excellent psychometric properties.

Measurement Issues: Measurement of posttraumatic stress disorder in children and young people - lessons from research and practice.

BACKGROUND: Many young people are exposed to traumatic events and a significant minority of these individuals will go on to experience posttraumatic stress disorder (PTSD). Valid and reliable measurement tools for assessing PTSD are essential and can aid screening, clinical diagnosis, treatment planning and outcome monitoring. METHODS: This article outlines the range of instruments available for these aspects of measurement, including assessment of PTSD in very young children, with a focus on those scales with good clinical utility and sound psychometric properties. FINDINGS: This is a particularly challenging time for clinicians working with children and young people with PTSD: all instruments will need to be revised and updated in order to better reflect the recent revisions to the diagnostic criteria for PTSD with the publication of the DSM-5 and no doubt the anticipated ICD-11. Despite this, measurement tools can still play a vital role in assessing PTSD in children and young people.

Reduced autobiographical memory specificity in bereaved Afghan adolescents.

This study investigated the effect of bereavement (father death due to war in Afghanistan) on autobiographical memory specificity in Afghan adolescents living in Iran. Participants consisted of bereaved (n=70) and non-bereaved (n=33) Afghan adolescents. The measures included Farsi versions of the Autobiographical Memory Test, Mood and Feeling Questionnaire, Revised Children's Manifest Anxiety Scale, and Impact of Event Scale. Results indicated that the bereaved group retrieved a significantly lower proportion of specific memories and a significantly greater proportion of extended and categoric memories than the non-bereaved group. Additionally, depression symptoms and reduced autobiographical memory specificity were significantly correlated. These findings suggest that bereaved adolescents have impaired autobiographical memory specificity.

Teaching Recovery Techniques (TRT) to Ukrainian children and adolescents to self-manage post-traumatic stress disorder (PTSD) symptoms following the Russian invasion of Ukraine in 2022 - The first 7 months.

BACKGROUND: The Russian invasion of Ukraine in February 2022 prompted many to provide mental health input, especially trauma management, to Ukrainian children and adolescents (C/A) exposed to it. METHODS: Rapid cascade training of 200 Ukrainian psychologists during 2022 to provide, in pairs, free of charge and without selection, TRT courses of 4-6, 90 min sessions online or face to face to C/A 7 to 23 years in Ukraine and those migrating abroad. CRIES-8 PTSD questionnaires were administered at the beginning and end of the courses during May-December 2022. Age, gender, their geographical war risk, and whether C/A had stayed or migrated elsewhere were collected. A CRIES-8 score of ≥17/40 defined likely PTSD. RESULTS: 3123 C/A completed an initial CRIES-8 questionnaire with matching demographics, 2737 a questionnaire at the end and 1798 both. At entry to TRT, likely PTSD was greater in females (65 %) than males (52 %, p < 0.001) declining with increasing age, particularly in males (p < 0.001). Migration had mixed effects and moving to lower war risk areas or abroad did not reduce PTSD risk. TRT benefited 68 % of C/A overall by reducing CRIES-8 from ≥17 to <17, the rate increasing the more experienced the TRT facilitators became (p < 0.0001). Online and face to face outcomes were the same. LIMITATIONS: The chaos of war prevented capture of all potential C/A questionnaires and long-term repeat testing not yet undertaken. CONCLUSIONS: Even in the chaos of war, effective mental health input can be rapidly and cheaply (c.50 USD/child) provided and should be encouraged.

Therapist-supported online cognitive therapy for post-traumatic stress disorder (PTSD) in young people: protocol for an early-stage, parallel-group, randomised controlled study (OPTYC trial).

INTRODUCTION: Post-traumatic stress disorder (PTSD) is a disabling psychiatric condition that affects a significant minority of young people exposed to traumatic events. Effective face-to-face psychological treatments for PTSD exist. However, most young people with PTSD do not receive evidence-based treatment. Remotely delivered digital interventions have potential to significantly improve treatment accessibility. Digital interventions have been successfully employed for young people with depression and anxiety, and for adults with PTSD. However, digital interventions to treat PTSD in young people have not been evaluated. The Online PTSD Treatment for Young People & Carers (OPTYC) trial will evaluate the feasibility, acceptability and initial indications of clinical efficacy of a novel internet-delivered Cognitive Therapy for treatment of PTSD in young people (iCT-PTSD-YP). METHODS AND ANALYSIS: This protocol describes a two-arm, parallel-groups, single-blind (outcome assessor), early-stage randomised controlled trial, comparing iCT-PTSD-YP with a waiting list (WL) comparator. N=34 adolescents (12-17 years old), whose primary problem is PTSD after exposure to a single traumatic event, will be recruited from 14 NHS Child and Adolescent Mental Health Services in London and southeast England, from secondary schools and primary care in the same region, or via self-referral from anywhere in the UK using the study website. Individual patient-level randomisation will allocate participants in a 1:1 ratio, randomised using minimisation according to sex and baseline symptom severity. The primary study outcomes are data on feasibility and acceptability, including recruitment, adherence, retention and adverse events (AEs). The primary clinical outcome is PTSD diagnosis 16 weeks post-randomisation. Secondary clinical outcomes include continuous measures of PTSD, anxiety and depression symptoms. Regression analyses will provide preliminary estimates of the effect of iCT-PTSD-YP on PTSD diagnosis, symptoms of PTSD, anxiety and depression relative to WL. Process-outcome evaluation will consider which mechanisms mediate recovery. Qualitative interviews with young people, families and therapists will evaluate acceptability. ETHICS AND DISSEMINATION: The study was approved by a UK Health Research Authority Research Ethics Committee (19/LO/1354). For participants aged under 16, informed consent will be provided by carers and the young person will be asked for their assent; participants aged 16 years or older can provide informed consent without their parent or caregiver's involvement. Findings will be disseminated broadly to participants, healthcare professionals, the public and other relevant groups. Study findings will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: ISRCTN16876240.

Development and validation of the Child Post-Traumatic Cognitions Inventory (CPTCI).

BACKGROUND: Negative trauma-related cognitions have been found to be a significant factor in the maintenance of post-traumatic stress disorder (PTSD) in adults. Initial studies of such appraisals in trauma-exposed children and adolescents suggest that this is an important line of research in youth, yet empirically validated measures for use with younger populations are lacking. A measure of negative trauma-related cognitions for use with children and adolescents, the Child Post-Traumatic Cognitions Inventory (CPTCI), is presented. The measure was devised as an age-appropriate version of the adult Post-Traumatic Cognitions Inventory (Foa et al., 1999). METHODS: The CPTCI was developed and validated within a large (n = 570) sample, comprising community and trauma-exposed samples of children and adolescents aged 6-18 years. RESULTS: Principal components analysis suggested a two-component structure. These components were labelled 'permanent and disturbing change' and 'fragile person in a scary world', and were each found to possess good internal consistency, test-retest reliability, convergent validity, and discriminative validity. The reliability and validity of these sub-scales was present regardless of whether the measure was completed in the acute phase or several months after a trauma. Scores on these sub-scales did not vary with age. CONCLUSIONS: The CPTCI is a reliable and valid measure that is not specific to the type of trauma exposure, and shows considerable promise as a research and clinical tool. The structure of this measure suggests that appraisals concerning the more abstract consequences of a trauma, as well as physical threat and vulnerability, are pertinent factors in trauma-exposed children and adolescents, even prepubescent children.

Computerized CBT for adolescent depression ("Stressbusters") and its initial evaluation through an extended case series.

BACKGROUND: "Stressbusters" is an interactive computer software programme based on a clinically effective face-to-face CBT protocol for young people with depression. It was designed for teenagers with mild to moderate depression, and comprises eight 45-minute sessions. METHOD: Twenty-three young people (aged 12-16; mean age 14.87 years) with symptoms of depression were recruited from CAMHS teams in Manchester and London, and received the Stressbusters treatment (range 1 - 8 sessions, mode 8 sessions). RESULTS: On the K-SADS at initial assessment, 95% met diagnostic criteria for a depressive disorder, with a high group mean score of 35.48 (SD 9.84) on the MFQ. Post-treatment, 22% of young people met criteria for a depressive disorder, with the group mean score on the MFQ falling significantly below clinical cut-off to 20.32 (SD 11.75). These gains were maintained at 3-month follow-up. Significant improvements were also found in the adolescents' global functioning (CGAS), self-reported anxiety (RCMAS), depressive cognitions and attributions (ATQ and CTI-C), and in adolescent- and parent-reported emotional and behavioural difficulties (SDQ). CONCLUSIONS: Taken together, these results provide promising preliminary data for the clinical efficacy of Stressbusters as a valid form of CCBT for adolescents with depression.

The impact of fathers' military deployment on child adjustment. The support needs of primary school children and their families separated during active military service: A pilot study.

BACKGROUND: Although direct exposure to war-related trauma negatively impacts children's psychological well-being, little is known about this impact within the context of parental military deployment to a combat zone and 'indirect' experience of the effects of armed conflict. This study investigates the impact of father's military deployment to Afghanistan on child well-being in primary schoolchildren and compares measures of adjustment with a matched group of children with fathers deployed on military training (non-combat) deployment. METHOD: Data were collected within primary schools in 2011-2012 from 52 children aged 8-11 years with fathers deploying to Afghanistan ( n = 26) and fathers deploying on military training ( n = 26) via self-completion of questionnaires assessing symptoms of anxiety, depression, stress and levels of self-esteem. Data were collected in both groups, at pre-, mid- and post-parental deployment. Class teachers and parents (non-deployed) completed a measure of child behaviour and parents completed a measure of parenting stress and general health. RESULTS: Unexpectedly child adjustment difficulties were not significantly raised in children whose parents deployed to Afghanistan. Ratings of behavioural difficulties and depression were low in both groups. However, clinically elevated levels of anxiety and stress symptoms were reported by both groups of children at each stage of deployment. No associations between parental stress, parental mental health and child adjustment were found. CONCLUSION: High levels of children's anxiety and stress reported during fathers' active military service warrant further investigation. Implications for school and health monitoring and CAMHS community liaison work are discussed.

Children and natural disasters.

The number of children affected by natural disasters each year is alarmingly high and can be expected to rise as climate change continues. The mental consequences have been documented not only in the rates of post-traumatic stress symptoms and post-traumatic stress disorder, but also for depression and other mental health problems. To contribute towards the knowledge in this area, this special issue of the European Journal of Psychotraumatology focuses on how children can be prepared for natural disasters and the mental health aspects of such events. It includes articles on communicating risks to children, involving children in disaster risk reduction, and the mental health consequences for children from an earthquake, a volcanic eruption, a flood and a hurricane. In this special issue specifically focusing on children and natural disasters, we hope to enhance our understanding of some of the complex pathways and pave the way for improving our interventions.

La cantidad de niños afectados cada año por desastres naturales es alarmantemente alta y es esperable que aumente a medida que el cambio climático continúa. Las consecuencias mentales se han documentado no solo en tasas de Síntomas de Estrés postraumático (SEPT) y Trastorno por Estrés postraumático (TEPT), sino en depresión y otros problemas de Salud Mental. Para contribuir a un mayor conocimiento, este ejemplar especial del Journal Europeo de Psicotraumatología se focaliza en como pueden prepararse los niños para los desastres naturales y los aspectos de salud mental de dichos eventos. Incluye artículos sobre la comunicación de riesgos a los niños, de involucrarlos en la reducción de riesgo de desastres, y las consecuencias de salud mental para niños por un terremoto, una erupción volcánica, una inundación y un huracán. En este ejemplar especial focalizado específicamente sobre niños y desastres naturales esperamos haber mejorado nuestra comprensión de algunas de los complejos senderos y pavimentado el camino para mejorar nuestras intervenciones.

Mental health of unaccompanied asylum-seeking adolescents previously held in British detention centres.

AIM: To investigate whether the mental health of unaccompanied asylum-seeking children (UASC) was negatively affected by having their ages disputed and being detained. METHOD: Participants within this cross-sectional study were 35 UASC, aged between 13 and 17 when they were detained. Some years later, a team of child mental health professionals interviewed them to assess their current mental health and to determine, as far as possible, the impact that having their age disputed and being detained may have had on their mental health. The Structured Clinical Interview for DSM-IV (SCID-IV), Reactions of Adolescents to Traumatic Stress (RATS), Stressful Life Events (SLE) and Detention Experiences Checklist-UK version (DEC-UK) were administered. RESULTS: The vast majority of UASC reported being negatively affected. Based on diagnostic interviews using the SCID-IV, self-report measures and contemporaneous records, the professionals reported a diagnosis of post-traumatic stress disorder (PTSD) developing in 29% ( n = 10), PTSD exacerbated in 51% ( n = 18), major depressive disorder (MDD) developing in 23% ( n = 8) and MDD exacerbated in 40% ( n = 14). A total of 3 years post-detention, 89% ( n = 31) met diagnostic criteria for psychiatric disorders and reported high PTSD symptoms. CONCLUSION: There was a high prevalence of psychiatric disorder. The additional stress of age dispute procedures and detention was judged to have been harmful.

Cognitive-behavioral therapy for PTSD in children and adolescents: a preliminary randomized controlled trial.

OBJECTIVE: To evaluate the efficacy of individual trauma-focused cognitive-behavioral therapy (CBT) for treating posttraumatic stress disorder (PTSD) in children and young people. METHOD: Following a 4-week symptom-monitoring baseline period, 24 children and young people (8-18 years old) who met full DSM-IV PTSD diagnostic criteria after experiencing single-incident traumatic events (motor vehicle accidents, interpersonal violence, or witnessing violence) were randomly allocated to a 10-week course of individual CBT or to placement on a waitlist (WL) for 10 weeks. RESULTS: Compared to the WL group, participants who received CBT showed significantly greater improvement in symptoms of PTSD, depression, and anxiety, with significantly better functioning. After CBT, 92% of participants no longer met criteria for PTSD; after WL, 42% of participants no longer met criteria. CBT gains were maintained at 6-month follow-up. Effects of CBT were partially mediated by changes in maladaptive cognitions, as predicted by cognitive models of PTSD. CONCLUSIONS: Individual trauma-focused CBT is an effective treatment for PTSD in children and young people.

Diagnostic, demographic, memory quality, and cognitive variables associated with acute stress disorder in children and adolescents.

To date, no studies have investigated factors associated with acute stress disorder (ASD) in children and adolescents. Relationships between ASD and a number of demographic, trauma, cognitive, and trauma memory variables were therefore investigated in a sample (N=93) of children and adolescents involved in assaults and motor vehicle accidents. Several cognitive variables and the quality of trauma memories, but not demographic or trauma variables, were correlated with ASD and also mediated the relationship between peritraumatic threat and ASD. Finally, nosological analyses comparing ASD with indexes of posttraumatic stress disorder in the month posttrauma revealed little support for the dissociation mandate that uniquely characterizes ASD. The results are discussed with respect to assessment and treatment for the acute traumatic stress responses of children and young people.

Parent and child agreement for acute stress disorder, post-traumatic stress disorder and other psychopathology in a prospective study of children and adolescents exposed to single-event trauma.

Examining parent-child agreement for Acute Stress Disorder (ASD) and Post-Traumatic Stress Disorder (PTSD) in children and adolescents is essential for informing the assessment of trauma-exposed children, yet no studies have examined this relationship using appropriate statistical techniques. Parent-child agreement for these disorders was examined by structured interview in a prospective study of assault and motor vehicle accident (MVA) child survivors, assessed at 2-4 weeks and 6 months post-trauma. Children were significantly more likely to meet criteria for ASD, as well as other ASD and PTSD symptom clusters, based on their own report than on their parent's report. Parent-child agreement for ASD was poor (Cohen's kappa = -.04), but fair for PTSD (Cohen's kappa = .21). Agreement ranged widely for other emotional disorders (Cohen's kappa = -.07-.64), with generalised anxiety disorder found to have superior parent-child agreement (when assessed by phi coefficients) relative to ASD and PTSD. The findings support the need to directly interview children and adolescents, particularly for the early screening of posttraumatic stress, and suggest that other anxiety disorders may have a clearer presentation post-trauma.

Pilot Study of a Group-Based Psychosocial Trauma Recovery Program in Secure Accommodation in Scotland.

The current study is the first to implement and evaluate a group-based trauma-specific program for adolescents in a secure accommodation facility in Scotland. A randomized control and qualitative pilot study compared an intervention group (n = 10), who received Teaching Recovery Techniques, to a waitlist control group (n = 7). Measures included subjective units of disturbance (SUDs), standardized trauma symptom questionnaires, and analysis of behavior monitoring logs. Adolescent interviews (n = 10) and a presenter focus group (n = 4) assessed program experience and views on future development. Sessions were videoed and analyzed for program adherence. Analysis involved MANOVA, and a quasi-qualitative thematic approach for participant views. Adolescents reported high SUDs and a range of trauma symptoms. A large effect size was found for reduced SUDs (d = 1.10) and positive trends were identified for symptoms and behavior change in the intervention group. Program adaptations included smaller groups, the use of visual materials and liaison with care staff to facilitate generalization. Recommendations are made for program development and large scale evaluation.

Posttraumatic Stress Disorder in Young Children 3 Years Posttrauma: Prevalence and Longitudinal Predictors.

OBJECTIVE: Age-appropriate criteria for posttraumatic stress disorder (PTSD) in young children have been established. The present study investigated the long-term course of such PTSD and its predictors in young children. METHODS: Young children (aged 2-10 years) and parents/caregivers who had attended emergency departments after motor vehicle collisions (MVCs) between May 2004 and November 2005 were assessed at 2 to 4 weeks and 6 months post-MVC; 71 families were re-interviewed 3 years post-MVC. Participants were assessed according to standard DSM-IV criteria for PTSD and a well-validated alternative algorithm for diagnosing PTSD in young children (PTSD-AA). Demographic, trauma-related, and parental mental health variables and intellectual ability were also assessed at baseline. RESULTS: Using an "optimal-report" procedure (a positive diagnosis according to parent or child for older children, or just parent for younger children), 7.0% met criteria for DSM-IV PTSD and 16.9% for PTSD-AA at 3 years. Using parent report alone, these rates were 1.4% and 2.8%, respectively. Parent-child agreement for PTSD and PTSD-AA was no better than chance (Cohen κ = -0.03 and -0.04, respectively). Baseline parent posttraumatic stress relating to the child's trauma, and not trauma severity, was correlated with optimal-report child PTSD-AA at each assessment (r values = 0.29-0.31) and accounted for unique variance in logistic regression models of this outcome at each assessment. CONCLUSIONS: PTSD-AA in young children can persist for years but is underrecognized by parents despite its being shaped to a large extent by parents' own acute traumatic stress in response to the child's trauma.

Conduct problems in adolescence: three domains of inhibition and effect of gender.

Behavioral and neuropsychological evidence has often shown that children with conduct disorder drawn from clinical populations show problems with impulsivity and are impaired in motor tasks of inhibitory control. We explored the relation between conduct problems and inhibitory deficits in a community sample. Three domains of inhibition were explored in 54 adolescents with conduct problems compared to 53 age, IQ, sex, school, and ethnicity matched controls in 2 geographical areas. Motor response inhibition was assessed using the Stop task, verbal inhibition using the Hayling Sentence Completion test, and cognitive interference inhibition using the Stroop task. Adolescents with conduct problems showed deficits in executive and inhibitory processes of the motor response inhibition task, but were unimpaired in cognitive or verbal inhibitory control. No sex differences were observed and impairments were independent of IQ or geographical location. Findings suggest that motor deficits, rather than higher cognitive forms of inhibitory control, are a specific deficit in children with conduct problems, that girls are as affected as boys, and that motor impulsiveness is a dimensional trait associated with conduct problems, as it is also observed in the community.