The Emotionally Sensitive Child-Adverse Parenting Experiences-Allostatic (Over)Load (ESCAPE-AL) Model for the Development of Secondary Psychopathic Traits.

Understanding and treatment of antisocial behavior have improved through efforts to subtype individuals based on similar risk factors and outcomes. In particular, the presence of psychopathic traits is associated with distinct etiological factors and antisocial behavior that begins early in life, is aggressive, persistent, and less likely to normalize with traditional treatments, relative to individuals low on psychopathy or its childhood precursor, callous-unemotional (CU) traits. However, important distinctions can be made within individuals with CU/psychopathic traits according to the presence of elevated anxiety symptoms and/or adverse childhood experiences, known as secondary psychopathy/CU traits. This paper provides a broad and brief overview of theory and empirical literature supporting the existence of secondary psychopathy/CU variants as a distinct subtype of childhood antisocial behavior. It outlines the Emotionally Sensitive Child-Adverse Parenting Experiences-Allostatic (Over)Load (ESCAPE-AL) model for the developmental psychopathology of secondary psychopathic/CU traits and discusses research and theory supporting this perspective. Future research directions for testing this conceptual model and its implications for assessing and treating high-risk individuals with secondary CU/psychopathic traits are discussed.

Prenatal tobacco exposure and the risk of conduct disorder symptoms in offspring at the age of 14 years: Findings from the Raine Study.

BACKGROUND: Emerging epidemiological evidence suggests that offspring born to mothers who smoked tobacco during pregnancy may have elevated risk of developing conduct disorder (CD) symptoms. We examined associations between maternal and paternal tobacco smoking during pregnancy and CD symptoms in offspring at the age of 14 years. METHODS: We obtained data from the Raine Study, a multi-generational cohort study based in Western Australia. DSM-oriented scale of the Child Behavior Checklist (CBCL) was used to measure CD symptoms in offspring. Negative binomial regression was used to estimate the rate ratio (risks) (RR) of CD symptoms in offspring. We also produced the E-values to investigate the extent of unmeasured confounding. Paternal smoking during pregnancy was used as a proxy for environmental tobacco smoke exposure. RESULTS: Complete data were available for 1747 mother-offspring and 1711 father-offspring pairs. After adjusting for potential confounders, we found elevated risks (rates) of CD symptoms in offspring born to mothers smoking tobacco during the first trimester [RR 1.52 (95 % CI: 1.24-1.87)], third trimester [RR 1.36 (95 % CI: 1.09-1.69)] and during both trimesters of pregnancy [RR 1.50 (95 % CI: 1.19-1.90)]. The rates of CD symptoms in offspring increased with the level of exposure to maternal smoking during pregnancy. However, we noted insufficient statistical evidence for an association between paternal smoking during pregnancy and CD symptoms in offspring. CONCLUSION: The associations we found for maternal but not paternal smoking may suggest a biological mechanism for intrauterine tobacco exposure on the risk of CD symptoms in offspring. Early interventions assisting pregnant mothers to quit tobacco smoking, or avoid smoking initiation, have potential to contribute health benefits to both mothers and their offspring.

The Role of Low Self-Control as a Mediator between Trauma and Antisociality/Criminality in Youth.

Trauma exposure and low self-control are robustly associated with youth antisocial/criminal problems, but the interrelation of these constructs is unclear when taking into account both traumatic events and reactions. The objective of the present study is to examine self-control mediation effects related to trauma and juvenile delinquency, conduct disorder, crime seriousness, and aggression outcomes. The sample consisted of N = 388 male youth from Portugal (age, M = 16.01 years, SD = 1.03, age range = 13-18 years). Path analysis procedures revealed that self-control partially mediates the relation between trauma events and the examined outcomes and fully mediates the relation between trauma reactions and the examined outcomes. Research on youth trauma should examine both trauma events and trauma reactions because they have differential effects on low self-control and antisocial/criminal outcomes.

Aspectos antissociais na velhice / Les aspects anti-sociaux de la vieillesse / Aspectos antisociales en la vejez / Antissocial aspects in ageing

Resumos Segundo Winnicott, a tendência antissocial tem por etiologia uma deprivação que ocorre quando está se dando a fusão entre os elementos instintuais e motores. A desfusão desses elementos resulta num prejuízo no desenvolvimento criativo das relações objetais e na expressão da agressividade. A tendência antissocial se manifesta através de um transtorno no ambiente, por meio da mentira, do roubo e da destrutividade. Neste artigo, apresento um caso clínico em que surgiram comportamentos antissociais numa pessoa idosa e como se constituiu o setting terapêutico para seu tratamento. Por fim, o texto discute se a etapa da vida que se conhece por velhice, por se apresentar amiúde com decadência física e declínio instintual, não causaria nos indivíduos uma deprivação que se expressaria por meio de múltiplos transtornos, normalmente percebidos como manifestações da mera velhice e que, na verdade, poderiam ser mais bem entendidos como expressão de uma tendência antissocial.

Résumé Selon Winnicott, la tendance antisociale résulte d'une privation qui se produit au moment où s'opère la fusion entre les éléments instinctuels et moteurs. La défusion de ces éléments entraîne une perte dans le développement créatif des relations objectales et dans l'expression de l'agressivité. La tendance antisociale se manifeste par une perturbation de l'environnement, par le mensonge, le vol et la destruction. Cet article présente un cas clinique dans lequel des comportements antisociaux se sont apparu chez une personne âgée et comment s'est constitué le cadre thérapeutique de son traitement. Enfin, le texte propose une réflexion : cette étape de la vie, que l'on nomme vieillesse et qui se présente souvent comme une déchéance physique et un déclin instinctif, ne provoquerait-elle chez les individus une déprivation qui s'exprimerait par de multiples troubles, normalement perçus comme des manifestations de la simple vieillesse mais qui, en fait, pourraient être mieux compris comme l'expression d'une tendance antisociale ?

Resumen Según Winnicott, la tendencia antisocial tiene por etiología una deprivación, que ocurre cuando los elementos instintuales y motores se están fusionando. La escisión entre estos elementos tiene como resultado un perjuicio en el desarrollo creativo de las relaciones objetales y la expresión de agresividad. La tendencia antisocial se manifiesta como una perturbación en el entorno mediante la mentira, el robo y la destructividad. En este artículo se presenta un caso clínico en el que surgieron comportamientos antisociales en una persona mayor y cómo se constituyó el setting terapéutico. Por último, se discute si la etapa de la vida conocida como vejez, por su decadencia física y el deterioro instintual en general, no les causaría a los individuos una deprivación, la cual se expresaría en múltiples desórdenes de la vejez que podrían entenderse como la expresión de una tendencia antisocial.

Abstract According to Winnicott, antisocial tendency etiology is an experience of deprivation that occurs during the fusion between instinctual and motor elements. These elements defusion impairs creative development of object relations and leads to an expression of aggression. In this scenario, the antisocial tendency is expressed by an environmental disorder, through lies, stealing, and destructivity. This article presents a clinical case of antisocial behaviors in an older person, describing the therapeutic setting for the treatment of such condition. Considering that ageing often presents with physical decadence and instinctual decline, it also discusses the association between this life period and a deprivation expressed through multiple disorders that are usually understood as signs of mere senescence but could possibly signify the expression of an antisocial tendency.

Breastfeeding for 3 Months or Longer but Not Probiotics Is Associated with Reduced Risk for Inattention/Hyperactivity and Conduct Problems in Very-Low-Birth-Weight Children at Early Primary School Age.

(1) Background: We aimed to evaluate the effect of proposed "microbiome-stabilising interventions", i.e., breastfeeding for ≥3 months and prophylactic use of Lactobacillus acidophilus/ Bifidobacterium infantis probiotics on neurocognitive and behavioral outcomes of very-low-birthweight (VLBW) children aged 5-6 years. (2) Methods: We performed a 5-year-follow-up assessment including a strength and difficulties questionnaire (SDQ) and an intelligence quotient (IQ) assessment using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI)-III test in preterm children previously enrolled in the German Neonatal Network (GNN). The analysis was restricted to children exposed to antenatal corticosteroids and postnatal antibiotics. (3) Results: 2467 primary school-aged children fulfilled the inclusion criteria. In multivariable linear regression models breastfeeding ≥3 months was associated with lower conduct disorders (B (95% confidence intervals (CI)): -0.25 (-0.47 to -0.03)) and inattention/hyperactivity (-0.46 (-0.81 to -0.10)) as measured by SDQ. Probiotic treatment during the neonatal period had no effect on SDQ scores or intelligence. (4) Conclusions: Prolonged breastfeeding of highly vulnerable infants may promote their mental health later in childhood, particularly by reducing risk for inattention/hyperactivity and conduct disorders. Future studies need to disentangle the underlying mechanisms during a critical time frame of development.

Psychiatric Disorders in the Adolescent Offspring of Mothers with Thyroid Problems During Pregnancy.

Maternal thyroid problems during pregnancy have been linked to neurocognitive impairments in children. While studies suggest that disorders of maternal thyroid function during pregnancy are associated with symptoms of mental health problems in children, little is known about the risk of clinically significant psychiatric disorders in adolescence. A sample of 2451 Canadian adolescents enrolled in the Ontario Child Health Study completed the Mini International Neuropsychiatric Interview for Children and Adolescents at 12-17 years of age. Their mothers self-reported thyroid problems during pregnancy. Gestational thyroid problems were associated with offspring oppositional defiant disorder (ODD; OR 3.73; 95% CI 1.69-8.24), conduct disorder (CD; OR 12.95; 95% CI 5.12-32.75), and social anxiety disorder (SAD; OR 6.25; 95% CI 2.53-15.47). Neither sex nor gestational age moderated associations between prenatal thyroid dysfunction and the majority of outcomes. School performance mediated 8% of the association between thyroid problems and SAD, 21% for CD and 53% for ODD.

Autonomic nervous system activity and callous-unemotional traits in physically maltreated youth.

BACKGROUND: Research into callous-unemotional (CU) traits often focuses exclusively on biological risk factors without integrating social factors. This gap exists despite a growing body of research showing that the social environment may actually impact physiological functioning, which could in turn affect behavior. OBJECTIVE: The current study addresses this limitation by examining physical maltreatment and heart rate stress reactivity as potential risk factors for CU traits. PARTICIPANTS AND SETTING: This research was conducted in a community sample of Chinese youth (mean age = 11.83 years, 44.3 % female). METHODS: Each child separately reported frequency of physical maltreatment experiences by his or her mother and father over the past 12 months. Children completed a self-report measure of CU traits. RESULTS: Frequency of maternal physical maltreatment was associated with uncaring traits in females, but not in males. Paternal physical maltreatment was associated with uncaring traits in both males and females and with callous traits in females only. While paternal physical maltreatment was associated with lower heart rate reactivity in females, maternal physical maltreatment was associated with higher heart rate reactivity in females. CONCLUSION: Findings provide mixed support for a potential physiological pathway through which child maltreatment may impact callous traits and provide a multilevel, biosocial lens through which to understand CU traits.

Modeling the Comorbidity of Cannabis Abuse and Conduct Disorder/Conduct Problems from a Cognitive Neuroscience Perspective.

Objective: A cognitive neuroscience perspective seeks to understand behavior, in this case the comorbidity of cannabis abuse and conduct disorder/conduct problems, in terms of dysfunction in cognitive processes underpinned by neural processes. The goal of this review is to articulate a cognitive neuroscience account of this comorbidity. Methods: Literature on the following issues will be reviewed: (i) the longitudinal relationship between cannabis abuse and conduct disorder/conduct problems (CD/CP); (ii) the extent to which there are genetic and environmental (specifically maltreatment) factors that underpin this relationship; (iii) forms of neurocognitive function that are reported dysfunctional in CD/CP and also, when dysfunctional, appear to be risk factors for future cannabis abuse; and (iv) the extent to which cannabis abuse may further compromise these systems leading to increased future abuse and greater conduct problems. Results: CD/CP typically predate cannabis abuse. There appear to be shared genetic factors that contribute to the relationship between CD/CP and cannabis abuse. Moreover, trauma exposure increases risk for both cannabis abuse and CP/CD. One form of neurocognitive dysfunction, response disinhibition, that likely exacerbates the symptomatology of many individuals with CD also appears to increase the risk for cannabis abuse. The literature with respect to other forms of neurocognitive dysfunction remains inconclusive. Conclusions: Based on the literature, a causal model of the comorbidity of cannabis abuse and CD/CP is developed.

Child Antisocial Behavior Is more Environmental in Origin in Disadvantaged Neighborhoods: Evidence Across Residents' Perceptions and Geographic Scales in Two Samples.

Prior research has suggested that disadvantaged neighborhood contexts alter the etiology of youth antisocial behavior (ASB). Unfortunately, these studies have relied exclusively on governmental data collected in administratively-defined neighborhoods (e.g., Census tracts or block groups, zip codes), a less than optimal approach for studying neighborhood effects. It would thus be important to extend prior findings of GxE using neighborhood sampling techniques, in which disadvantage is assessed via resident informant-reports of the neighborhood. The current study sought to do just this, examining two independent twin samples from the Michigan State University Twin Registry. Neighborhood disadvantage was assessed via maternal and neighbor informant-reports, the latter of which were analyzed multiple ways (i.e., all neighbors within 1 km, nearest neighbor, and all neighbors within the County). Analyses revealed clear and consistent evidence of moderation by neighborhood disadvantage, regardless of informant or the specific operationalization of neighborhood. Shared environmental influences on ASB were observed to be several-fold larger in disadvantaged contexts, while genetic influences were proportionally more influential in advantaged neighborhoods. Such findings indicate that neighborhood disadvantage exerts rather profound effects on the origins of youth ASB. Efforts should now be made to identify the active ingredients of neighborhood disadvantage.

Prevalence and patterns of mental disorders among primary school age children in Ghana: correlates with academic achievement.

Background: There is limited data on the prevalence of child and adolescent mental health disorders (CAMHD) in Ghana. Recent reports suggest a decline in academic achievement in basic education. This paper sought to determine the prevalence of CAMHD in Ghanaian primary school children and to draw correlates with academic achievement.Methods: We conducted a pilot cross-sectional survey of 303 grade 3 pupils aged 7-15 years in the city of Kumasi. The Child Behaviour Checklist (CBCL) and Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS-PL) were used to assess for CAMHD in 2016, and data on performance in examinations over the prior academic year were analysed.Results: Overall, current prevalence of CAMHD was 7.25%, with depressive disorder = 1.31%, anxiety disorders = 1%, attention deficit hyperactivity disorder (ADHD) = 1.64%, conduct disorder = 1.97%, and intellectual disability = 1%. Co-morbid disorders, such as seizure disorder (1%), were also noted. There was a greater prevalence of CAMHD in public schools (11.6%) compared to private schools (0.7%), with p < 0.001. Even when adjusted for other factors, children with CAMHD had a lower average academic score by 10.5 units (p < 0.001). Thus, having a dual diagnosis was most predictive of academic underachievement.Conclusions: The results of this study document the prevalence of CAMHD in Ghana for the first time and shows correlates with academic underachievement.

Trajectories and Predictors of Children's Early-Starting Conduct Problems: Child, Family, Genetic, and Intervention Effects.

Several research teams have previously traced patterns of emerging conduct problems (CP) from early or middle childhood. The current study expands on this previous literature by using a genetically-informed, experimental, and long-term longitudinal design to examine trajectories of early-emerging conduct problems and early childhood discriminators of such patterns from the toddler period to adolescence. The sample represents a cohort of 731 toddlers and diverse families recruited based on socioeconomic, child, and family risk, varying in urbanicity and assessed on nine occasions between ages 2 and 14. In addition to examining child, family, and community level discriminators of patterns of emerging conduct problems, we were able to account for genetic susceptibility using polygenic scores and the study's experimental design to determine whether random assignment to the Family Check-Up (FCU) discriminated trajectory groups. In addition, in accord with differential susceptibility theory, we tested whether the effects of the FCU were stronger for those children with higher genetic susceptibility. Results augmented previous findings documenting the influence of child (inhibitory control [IC], gender) and family (harsh parenting, parental depression, and educational attainment) risk. In addition, children in the FCU were overrepresented in the persistent low versus persistent high CP group, but such direct effects were qualified by an interaction between the intervention and genetic susceptibility that was consistent with differential susceptibility. Implications are discussed for early identification and specifically, prevention efforts addressing early child and family risk.

Developmental Trajectories of Conduct Problems and Cumulative Risk from Early Childhood to Adolescence.

Pathways into and out of conduct problems differ by circumstances experienced since infancy. There is a research gap in understanding how these developmental patterns vary according to the timing and persistence of risk and whether there are differences across ecological domains. This study examines variations in trajectories of conduct problems between ages 3 to 14 years and associated child, family and socio-economic risk factors from ages 9 months to 14 years, drawing on the UK Millennium Cohort Study (n = 17,206, 49% female), a nationally representative longitudinal study of children born between 2000/02. Group-based modeling was used to identify four distinct trajectories of conduct problems: low (56%), persistent high (8%), childhood-limited (23%) and adolescent-onset (13%). All three problem pathways were associated with high levels of exposure to risk, particularly early socio-economic and persisting child and family risks. However, while for the persistent and adolescent-onset pathways, exposure to higher levels of family and child risks continued through adolescence, it receded for the childhood-limited trajectory. The effects of early socio-economic disadvantage persisted for those on the adolescent-onset trajectory, highlighting the importance of early markers for this later onset group. Maternal smoking in pregnancy continued to be a significant predictor for all three conduct problem groups, even up to age 14 years. The findings indicate that different influences and processes may explain diverse pathways of conduct problems. This offers insights into who and what might be targeted and when might be the most effective developmental window for intervention.

Parenting and Cortisol in Infancy Interactively Predict Conduct Problems and Callous-Unemotional Behaviors in Childhood.

This study examines observed maternal sensitivity, harsh-intrusion, and mental-state talk in infancy as predictors of conduct problems (CP) and callous-unemotional (CU) behaviors in middle childhood, as well as the extent to which infants' resting cortisol and cortisol reactivity moderate these associations. Using data from the Family Life Project (n = 1,292), results indicate that maternal sensitivity at 6 months predicts fewer CP at first grade, but only for infants who demonstrate high levels of cortisol reactivity. Maternal harsh intrusion predicts fewer empathic-prosocial behaviors, a component of CU behaviors, but only for infants who demonstrate high resting cortisol. Findings are discussed in the context of diathesis-stress and differential susceptibility models.

Callous-Unemotional Behaviors and Harsh Parenting: Reciprocal Associations across Early Childhood and Moderation by Inherited Risk.

Callous-unemotional (CU) behaviors increase children's risk for subsequent antisocial behavior. This risk process may begin in early childhood with reciprocal pathways between CU behaviors and harsh parenting. In a sample of 561 linked triads of biological mothers, adoptive parents, and adopted children, the present study examined bidirectional links between CU behaviors and harsh parenting across three time points from 18 to 54 months and investigated moderation by inherited risk for psychopathic traits. Child CU behaviors and harsh parenting were measured using adoptive mother and adoptive father reports, and biological mothers provided reports of their personality characteristics. Findings supported reciprocal associations between harsh parenting and CU behaviors during early childhood, especially during the transition from toddlerhood (27 months) to the preschool period (54 months). Moreover, multiple-group analyses showed that level of inherited risk moderated associations between CU behaviors and harsh parenting. Specifically, there were statistically reliable associations between CU behaviors at 27 months and adoptive mothers' harsh parenting at 54 months, and between adoptive fathers' harsh parenting at 27 months and CU behaviors at 54 months among children at higher inherited risk, but not among those at lower inherited risk. The findings illustrate the dynamic interplay between parenting, CU behaviors, and heritable risk.

Mental health in South African adolescents living with HIV: correlates of internalising and externalising symptoms.

Although declining in all other age groups, AIDS-related deaths among adolescents are increasing. In the context of HIV, mental health problems are associated with negative health outcomes, including non-adherence to life-saving ART. For effective programming it is essential to identify factors associated with psychological outcomes in this population. Adopting a socioecological perspective, we aimed to identify correlates of internalising and externalising symptoms in a large, representative sample of South African adolescents living with HIV. HIV-positive adolescents (n = 1060), who received care in public health facilities in South Africa's Eastern Cape, completed measures of internalising and externalising symptoms. Hypothesised correlates included HIV and health-related factors (physical health, mode of infection, medication side-effects, disclosure, stigma), health-service related factors (negative interactions with clinic staff, clinic support group), interpersonal factors (abuse, bullying victimisation, social support), parenting-related factors (orphanhood, positive parenting, parental monitoring, parent communication), as well as individual and demographic-related factors (self-efficacy, age, gender, urban/rural location, poverty). Correlates operating across a variety of contexts were identified. Bullying victimisation, self-efficacy, and positive parenting may be particularly salient intervention targets as they were associated with better outcomes on most or all mental health measures, can be addressed without directly targeting adolescents living with HIV (reducing the chances of accidental exposure and stigma), and are associated with better adolescent mental health in South Africa more generally.

Disciplinary Parenting Practice and Child Mental Health: Evidence From the UK Millennium Cohort Study.

OBJECTIVE: To investigate whether a longitudinal association exists between differential disciplinary parenting practices at 3 years of age and later child psychopathology at 11 years. METHOD: Data were obtained from the Millennium Cohort Study, a UK-wide cohort. Discipline style was assessed using a validated maternal reported questionnaire at 3 years of age for which later outcome data were available. "Active" (including smacking, shouting, and telling off) and "withdrawal" (including ignoring, removal of privileges, and sending to bedroom) approaches were distinguished. Child emotional and behavioral problems were assessed at 3 and 11 years of age using the maternally completed Strengths and Difficulties Questionnaire (SDQ). The independence of associations between early discipline and later child mental health was investigated using mutually adjusted regression analyses and potential reverse causality was considered by looking at changes in SDQ subscale scores from 3 to 11 years. RESULTS: Differential associations with change in child psychopathology according to discipline type were observed. Active and withdrawal forms of discipline were associated with a decrease in conduct problems from 3 to 11 years (active, ß = -0.28, 95% CI -0.34 to -0.21, p < .001; withdrawal, ß = -0.19, 95% CI -0.24 to -014, p < .001). However, active approaches also were associated with an increase in emotional problems (ß = 0.07, 95% CI 0.00-0.14, p = .03) not observed for withdrawal approaches. CONCLUSION: Different approaches to discipline appear to have differential associations with later child mental health. Further research accounting for a larger number of parent and child characteristics is needed to assess whether such associations are causal.

Health impacts of parental migration on left-behind children and adolescents: a systematic review and meta-analysis.

BACKGROUND: Globally, a growing number of children and adolescents are left behind when parents migrate. We investigated the effect of parental migration on the health of left behind-children and adolescents in low-income and middle-income countries (LMICs). METHODS: For this systematic review and meta-analysis we searched MEDLINE, Embase, CINAHL, the Cochrane Library, Web of Science, PsychINFO, Global Index Medicus, Scopus, and Popline from inception to April 27, 2017, without language restrictions, for observational studies investigating the effects of parental migration on nutrition, mental health, unintentional injuries, infectious disease, substance use, unprotected sex, early pregnancy, and abuse in left-behind children (aged 0-19 years) in LMICs. We excluded studies in which less than 50% of participants were aged 0-19 years, the mean or median age of participants was more than 19 years, fewer than 50% of parents had migrated for more than 6 months, or the mean or median duration of migration was less than 6 months. We screened studies using systematic review software and extracted summary estimates from published reports independently. The main outcomes were risk and prevalence of health outcomes, including nutrition (stunting, wasting, underweight, overweight and obesity, low birthweight, and anaemia), mental health (depressive disorder, anxiety disorder, conduct disorders, self-harm, and suicide), unintentional injuries, substance use, abuse, and infectious disease. We calculated pooled risk ratios (RRs) and standardised mean differences (SMDs) using random-effects models. This study is registered with PROSPERO, number CRD42017064871. FINDINGS: Our search identified 10 284 records, of which 111 studies were included for analysis, including a total of 264 967 children (n=106 167 left-behind children and adolescents; n=158 800 children and adolescents of non-migrant parents). 91 studies were done in China and focused on effects of internal labour migration. Compared with children of non-migrants, left-behind children had increased risk of depression and higher depression scores (RR 1·52 [95% CI 1·27-1·82]; SMD 0·16 [0·10-0·21]), anxiety (RR 1·85 [1·36-2·53]; SMD 0·18 [0·11-0·26]), suicidal ideation (RR 1·70 [1·28-2·26]), conduct disorder (SMD 0·16 [0·04-0·28]), substance use (RR 1·24 [1·00-1·52]), wasting (RR 1·13 [1·02-1·24]) and stunting (RR 1·12 [1·00-1·26]). No differences were identified between left-behind children and children of non-migrants for other nutrition outcomes, unintentional injury, abuse, or diarrhoea. No studies reported outcomes for other infectious diseases, self-harm, unprotected sex, or early pregnancy. Study quality varied across the included studies, with 43% of studies at high or unclear risk of bias across five or more domains. INTERPRETATION: Parental migration is detrimental to the health of left-behind children and adolescents, with no evidence of any benefit. Policy makers and health-care professionals need to take action to improve the health of these young people. FUNDING: Wellcome Trust.

Encefalitis anti-NMDA en mujer anciana. A propósito de un caso / Anti-NMDA receptor encephalitis in an elderly patient: A case report

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Longitudinal, reciprocal relationships between family management and antisocial peer associations.

INTRODUCTION: Poor family management and antisocial peer associations are related risk factors for negative outcomes such as adolescent substance misuse and conduct disorders. The relationship between family management and antisocial peer associations is complex. The purpose of this study was to test the reciprocal relationships between youth-reports of poor family management and antisocial peer associations over multiple time-points. METHODS: We used four data points (5th-11th grade) from the Australian arm of the longitudinal International Youth Development Study (IYDS) to test a random-intercepts cross-lagged path model (N = 922). RESULTS: The model fit the data well with path estimates showing that poor family management predicted greater antisocial peer associations at the next wave but not the reverse. A second model included a third autoregressive path to control for youth's own antisocial behavior; the direction of the relationships between poor family management and antisocial peer associations did not change. CONCLUSIONS: These results indicate that across adolescence poor family management predicts greater antisocial peer association, which provides evidence that family-focused interventions are an important prevention strategy even in adolescence.

Avoiding antisocial behavior among adolescents: The positive influence of classmates' prosocial behavior.

INTRODUCTION: Prior research has shown that classmates' behavior serves as a descriptive norm for adolescents' individual behavior. While earlier studies primarily focused on negative peer influence, classmates' prosocial behavior might be associated with positive individual development. We hypothesized more classroom-level prosocial behavior predicts a lower likelihood of future antisocial behavior of individual students over and above the effect of classmates' antisocial behavior. We further assumed this effect is mediated by adolescents' attitudes toward antisocial behavior. METHODS: To test our hypotheses, we used three data collection points from a longitudinal study among lower secondary school students in Switzerland (N = 864; mean age at T1: 13.81 years; male gender: 52%). Participants completed self-reported assessments on prosocial behavior, antisocial behavior, and antisocial attitudes. Data were analyzed using multilevel models. RESULTS: Results indicated higher levels of prosocial behavior among classmates predict lower levels of individual students' future antisocial behavior. However, the effect of classmates' prosocial behavior was not mediated by individual attitudes toward antisocial behavior. CONCLUSIONS: While in the context of antisocial behavior the peer group is often assumed a risk, our results indicate that school peers can also exert positive influence. Hereby our finding of an effect of prosocial peer norms over and above antisocial peer norms suggests that building up prosocial behaviors in the classroom may be a promising approach for the prevention of antisocial behavior.