Temperament and adolescent suicide attempts: a case-control study with multi-ethnic Asian adolescents.

BACKGROUND: Suicide is the leading cause of death for adolescents in several parts of Asia, including Singapore. This study examines the relationship between temperament and youth suicide attempts in a sample of multi-ethnic Singaporean adolescents. METHODS: A case-control design compared 60 adolescents (Mage = 16.40, SDage = 2.00) with a recent suicide attempt (i.e., past 6 months) with 58 adolescents (Mage = 16.00, SDage = 1.68) without any history of suicide attempts. Presence of suicide attempts was established using the semi-structured interviewer-administered Columbia Suicide Severity Rating Scale. Participants also completed self-report measures on temperament traits, psychiatric diagnoses, stressful life events, and perceived parental rejection in an interview-based format. RESULTS: Psychiatric comorbidity, recent stressful life events, perceived parental rejection, and all five "difficult temperament" traits, were significantly overrepresented among adolescent cases relative to healthy controls. Adjusted logistic regression models revealed significant associations between suicide attempt, MDD comorbidity (OR: 10.7, 95% Cl: (2.24-51.39)), "negative mood" trait (OR: 1.12-1.18, 95% Cl: (1.00-1.27)), and the interaction term of "positive mood" and "high adaptability" traits (OR: 0.943 - 0.955, 95% Cl: (0.900 - 0.986)). Specifically, "positive mood" predicted lower likelihood of a suicide attempt when "adaptability" was high (OR: 0.335 - 0.342, 95% Cl: (0.186 - 0.500)) but not low (OR: 0.968 - 0.993, 95% Cl: (0.797 - 1.31)). CONCLUSION: Temperament screening may be important to identify adolescents at higher or lower risk of suicide at an early stage. More longitudinal and neurobiological research converging on these temperament findings will be helpful in ascertaining temperament screening as an effective suicide prevention methodology for adolescents.

Temperament, parenting, mental disorders, life stressors and help-seeking behavior of Asian adolescent suicide attempters: A case control study.

Purpose: The need to elucidate risk factors for adolescent suicide is urgent, as suicide consistently ranks among the top causes of death globally. Understanding suicide risk factors could inform more effective interventions. Previous studies have identified certain risk factors associated with suicide, but there is a paucity of research among adolescent and multi-ethnic Asian populations. Materials and methods: This case-control study sampled 13-to-19-year-old Asian adolescents who had attempted suicide (N = 60) and controls (N = 58) matched by age, ethnicity and gender at group-level (73.7% female). Life stressors, temperament, parenting style, mental health conditions and help-seeking behavior were examined. Results: All domains of life stress apart from emerging adult responsibility were higher among cases than controls, especially home life, peer pressure and romantic relationships. Suicide attempters tended to avoid new situations, be less adaptable to changes, have a negative outlook and irregular sleep-wake cycle. Additionally, they perceived their parents to be significantly more aggressive, neglecting, rejecting and cold, while parents' perceptions of their own parenting were only significantly different in the domain of parental neglect. Cases were more likely to exhibit disorders of disruptive behavior, eating, mood, anxiety, symptoms of schizophrenia and experience of disturbing events. Significant differences were also found for 10 out of 12 Axis II disorders, particularly borderline, depressive, and avoidant personality disorder traits. No significant case-control differences were found regarding overall rates of help-seeking. Conclusion: Findings from this study may help in suicide prevention efforts through more tailored interventions.

'Caring for children who have experienced trauma' - an evaluation of a training for foster parents.

BACKGROUND: Foster children, mostly maltreated in their birth families, may be fostered by parents who know little about the impact of traumatic experiences. OBJECTIVE: The present study investigated whether the training Caring for Children who Have Experienced Trauma for foster parents can break the negative circle of traumatic stress. The hypothesis was that improvement in parents' knowledge on trauma and mind-mindedness would be associated with a reduction of their parenting stress, children's post-traumatic stress symptoms, and behaviour problems. METHOD: Forty-eight foster parents (n female = 35) participated in a pre-test (T1), post-test (T2), and follow-up (T3) assessment. Questionnaires on knowledge on trauma, parenting stress, child post-traumatic stress symptoms, the child's behaviour, and the evaluation of the training were administered. Parents' mind-mindedness was assessed using the describe-your-child interview. RESULTS: Foster parents highly appreciated the training, their knowledge on child trauma increased at T2 and this growth persisted at T3. The parents who gained most knowledge experienced a small decrease in parenting stress at T2. Although the general mind-mindedness did not significantly change, foster parents' mind-mindedness with positive valence substantially increased at T2 and T3, while their mind-mindedness with neutral valence decreased. Foster parents' report on child PTSS declined at T3 compared to T2, but not compared to T1. No changes were found in children's behaviour as reported by the foster parents. The proportion of foster children receiving trauma-focused treatment increased at T2 and T3. CONCLUSION: This study provides evidence that training in trauma-informed parenting can be effective in improving foster parents' knowledge on the impact of traumatic experiences and in increasing a positive mental representation of their foster child as well as in reducing children's post-traumatic symptoms.

Antecedentes: Los niños acogidos, en su mayoría maltratados en sus familias de origen, pueden ser criados por padres que sepan poco acerca del impacto de las experiencias traumáticas.Objetivo: El presente estudio investigó si el entrenamiento 'Cuidando de Niños que han experimentado un Trauma' para padres de acogida puede romper el círculo negativo del estrés traumático. La hipótesis fue que el mejoramiento del conocimiento de los padres en el trauma y la mente mentalizante, disminuye el estrés de la paternidad, los síntomas post-traumáticos de los niños, y sus problemas conductuales.Método: Cuarenta y ocho padres sustitutos (n de mujeres=35) participaron en pre-test (T1), post-test (T2) y seguimiento (T3). Se administraron cuestionarios sobre conocimientos en trauma, estrés de la paternidad, síntomas postraumáticos de los niños, problemas conductuales, comportamiento prosocial y de evaluación del entrenamiento. Se evaluó la mente mentalizante de los padres mediante una entrevista describe-a-tu-hijo.Resultados: Los padres sustitutos apreciaron mucho el entrenamiento, su conocimiento en trauma infantil se incrementó en T2 y este crecimiento persistió en T3. Los padres que ganaron más conocimiento experimentaron una pequeña disminución en estrés de la paternidad en T2. Aunque la mente mentalizante en general no tuvo un cambio significativo, la mente mentalizante de los padres sustitutos con valencia positiva se incrementó sustancialmente en T2 y T3, mientras que su mente mentalizante con valencia neutral disminuyó. El reporte de los padres de acogida sobre los síntomas postraumáticos de los niños disminuyó en T3, comparado con T2 pero no respecto a T1. No se encontraron cambios en la conducta de los niños de acuerdo al reporte de los padres de acogida. La proporción de los niños que inició un tratamiento centrado en trauma se incrementó en T2 y T3.Conclusión: Este estudio provee evidencia de que el entrenamiento puede ser efectivo en mejorar el conocimiento de los padres de acogida en el impacto de las experiencias traumáticas y en aumentar una representación mental positiva de sus hijos de acogida así como también en reducir los síntomas postraumáticos de los niños.

Hikikomori Phenomenon in East Asia: Regional Perspectives, Challenges, and Opportunities for Social Health Agencies.

Hikikomori, which originated in Japan, refers to the condition where youths withdraw into the home and do not participate in society for an extended period of time. Recent updates on hikikomori presentation within the region were exchanged at a Hikikomori Round Table and Regional Symposium (HRTRS) discussion late 2017, leading to this perspective paper. Hikikomori presents as an overall homogeneous construct, while diversity in clinical presentation exists across East Asian countries. We examined the various presentations, risk factors, theoretical frameworks, and classification issues about hikikomori. In particular, specific risk factors have emerged to some degree across the region, while some are more locale specific. We propose that hikikomori youths have differential onset and developmental patterns, potentially resulting in heterogeneous presentation. We briefly summarized existing interventions in the East Asian region. Intervention strategies need to be tailored to different subtypes. A multicomponent approach would address complexity, multifactorial onset, and development of the condition. The HRTRS presented to participating countries the opportunity to collectively work toward a more universal definition of the hikikomori condition and explored innovative ways to shape existing service structures. Opportunities for participating countries described pertain to early detection of cases, adoption of assessment tools, and improved intervention services.

Contextual risk factors as predictors of disruptive behavior disorder trajectories in girls: the moderating effect of callous-unemotional features.

BACKGROUND: The presence of callous-unemotional (CU) features may delineate a severe and persistent form of conduct problems in children with unique developmental origins. Contextual risk factors such as poor parenting, delinquent peers, or neighborhood risk are believed to influence the development of conduct problems primarily in children with low levels of CU features. However, longitudinal studies examining the moderating effect of CU features on the relation between contextual risk factors and conduct problems trajectories in girls are rare. METHODS: Growth curve analysis was conducted using five annual measurements of oppositional defiant disorder/conduct disorder (ODD/CD) behaviors in a community sample of 1,233 girls aged 7-8 at study onset. The relation between contextual risk factors in multiple domains (i.e., family, peer, community) and trajectories of ODD/CD behaviors across time were examined for girls with differing levels of CU features. RESULTS: Growth curve analysis indicated that CU features were associated with chronically high levels of ODD/CD symptoms over time. Low levels of parental warmth were also associated with chronically high levels of ODD/CD, and this effect was particularly pronounced for girls with high CU features. Exposure to harsh parenting was associated with higher ODD/CD behaviors for girls in childhood regardless of their level of CU features, but this effect dissipated over time. CONCLUSIONS: Girls with elevated CU features who are exposed to low levels of parental warmth seem to exhibit particularly severe ODD/CD symptoms and should be targeted for intensive intervention in childhood.

Girls' Disruptive Behavior and its Relationship to Family Functioning: A Review.

Although a number of reviews of gender differences in disruptive behavior and parental socialization exist, we extend this literature by addressing the question of differential development among girls and by placing both disruptive behavior and parenting behavior in a developmental framework. Clarifying the heterogeneity of development in girls is important for developing and optimizing gender-specific prevention and treatment programs. In the current review, we describe the unique aspects of the development of disruptive behavior in girls and explore how the gender-specific development of disruptive behavior can be explained by family linked risk and protective processes. Based on this review, we formulate a gender-specific reciprocal model of the influence of social factors on the development of disruptive behavior in girls in order to steer further research and better inform prevention and treatment programs.

Is neighborhood context differently related to externalizing problems and delinquency for girls compared with boys?

Although a number of reviews of gender differences in conduct problems and delinquency exist, this paper fills a gap in reviewing neighborhood influences on gender differences in conduct problems and delinquency. These influences are known to be important for boys in childhood and adolescence, but cannot be assumed to be influential in the same manner for girls. The paper starts with several conceptualizations of the association between gender, neighborhoods and juvenile delinquency. It then addresses 4 key questions. Is residing in a disadvantaged neighborhood associated with problem behavior in girls? Are neighborhood effects independent of girls' age? Are girls in disadvantaged neighborhoods exposed to more risk factors than girls in advantaged neighborhoods? Can mediating risk factors explain gender differences in neighborhood effects on children's and adolescents' conduct problems and delinquent behavior? Answers to these questions are important to steer research and elucidate aspects of interventions that can be optimized for girls.

Characteristics of girls with early onset disruptive and antisocial behaviour.

BACKGROUND: Crime, particularly among juvenile females, has increased in recent years. Little is known, however, about the development and precursors in childhood of female delinquent behaviour. This is primarily due to a lack of consensus on how to define and assess female antisocial behaviour, and a lack of studies using sufficiently large samples. METHOD: A community sample of 2451 girls between the ages of five and eight years were recruited into a longitudinal study following the enumeration of 103,238 households in the city of Pittsburgh. Data on disruptive and antisocial behaviours were collected from parents, teachers and children during the first wave of the study. RESULTS: Prevalence rates of disruptive disorders varied by choice of informants and measurement thresholds. The prevalence of most disruptive behaviours was similar across the four age cohorts. Where there were differences, parents of younger girls tended to report fewer problematic behaviours compared with parents of older girls. Teachers reported more disruptive behaviours than parents and, by their reports, older girls were more likely to show oppositional/defiant behaviour and relational aggression than younger girls. Girls scoring highly on several domains relative to their peers were over-represented in disadvantaged neighbourhoods. CONCLUSIONS: A range of disruptive disorders are present among a subgroup of females at an early age, particularly among girls in the most disadvantaged neighbourhoods. Longitudinal follow-up is required to examine the developmental trajectories and predictive utility of these behaviours. The implications for clinical interventions are discussed.