The Proposed Specifiers for Conduct Disorder - Parent (PSCD-P): Convergent Validity, Incremental Validity, and Reactions to Unfamiliar Peer Confederates.

Youth who experience psychopathy display multiple impairments across interpersonal (grandiose-manipulative [GM]), affective (callous-unemotional [CU]), lifestyle (daring-impulsive [DI]), and potentially antisocial and behavioral features. Recently, it has been acknowledged that the inclusion of psychopathic features can offer valuable information in relation to the etiology of Conduct Disorder (CD). Yet, prior work largely focuses on the affective component of psychopathy, namely CU. This focus creates uncertainty in the literature on the incremental value of a multicomponent approach to understanding CD-linked domains. Consequently, researchers developed the Proposed Specifiers for Conduct Disorder (PSCD; Salekin & Hare, 2016) as a multicomponent approach to assess GM, CU, and DI features in combination with CD symptoms. The notion of considering the wider set of psychopathic features for CD specification requires testing whether multiple personality dimensions predict domain-relevant criterion outcomes above-and-beyond a CU-based approach. Thus, we tested the psychometric properties of parents' reports on the PSCD (PSCD-P) in a mixed clinical/community sample of 134 adolescents (Mage = 14.49, 66.4% female). Confirmatory factor analyses resulted in a 19-item PSCD-P displaying acceptable reliability estimates and a bifactor solution consisting of GM, CU, DI, and CD factors. Findings supported the incremental validity of scores taken from the PSCD-P across multiple criterion variables, including (a) an established survey measure of parent-adolescent conflict; and (b) trained independent observers' ratings of adolescents' behavioral reactions to laboratory controlled tasks designed to simulate social interactions with unfamiliar peers. These findings have important implications for future research on the PSCD and links to adolescents' interpersonal functioning.

At the heart of change: Differences in young offenders' HRV patterns after the delivery of the PSYCHOPATHY.COMP program.

Introduction: Literature has pointed the need for intervention programs specifically tailored to target the treatment needs of young offenders, as well as the need to test the efficacy of such programs through physiological indexes of emotion regulation (e.g., heart rate variability; HRV), complementing self-reports typically used as outcome measures. The PSYCHOPATHY.COMP is a 20-session individual intervention program based on Compassion Focused Therapy aiming to reduce psychopathic traits and disruptive behavior among young offenders through the development of a compassionate motivation, while stimulating the soothing system as a strategy to improve emotion regulation. Previous research with young offenders has shown decreases in vagally mediated HRV (vmHRV) when the soothing system is activated. This physiological pattern seems to mirror threat-like responses that contrast with relaxed states. Methods: To test the efficacy of the PSYCHOPATHY.COMP, a clinical trial was implemented encompassing a treatment (n = 56) and a control group (n = 53). Treatment participants attended the PSYCHOPATHY.COMP, while controls received the Treatment As Usual (TAU) delivered in Portuguese juvenile detention facilities. HRV data was collected throughout a standardized procedure (encompassing resting, reactivity and recovery phases) specifically designed to trigger the soothing system. Participants were assessed at pre-treatment, post-treatment and 6-months follow-up. Results: Although treatment participants continued to process the soothing system as unpleasant (with decreased vmHRV), they seem to become able to adaptively recover from the stimuli without avoiding it or resorting to maladaptive coping strategies. The physiological pattern was in line with participants' decreases in difficulties in emotion regulation across the assessment periods. In contrast, controls seemed to have actively employed coping strategies associated with increases in vmHRV not only when the soothing system was triggered, but also when recovering from the stimuli. Congruently, for controls, increases in difficulties in emotion regulation were found, with increases in the lack of emotional clarity across the assessment periods. Discussion: Findings offer new evidence for the efficacy of the PSYCHOPATHY.COMP program in improving emotion regulation in young offenders, assessed through both self-report and physiological measures. Additionally, findings support the assessment of the autonomic balance as a treatment efficacy index in future research, targeting the rehabilitation of these youth. Clinical trial registration: ClinicalTrials.gov, identifier NCT03971682.

Intronic Variant in CNTNAP2 Gene in a Boy With Remarkable Conduct Disorder, Minor Facial Features, Mild Intellectual Disability, and Seizures.

Introduction: Mutations in the contactin-associated protein-like 2 (CNTNAP2) gene (MIM#604569) encoding for CASPR2, a cell adhesion protein of the neurexin family, are known to be associated with autism, intellectual disability, and other neuropsychiatric disorders. A set of intronic deletions of CNTNAP2 gene has also been suggested to have a causative role in individuals with a wide phenotypic spectrum, including Pitt-Hopkins syndrome, cortical dysplasia-focal epilepsy syndrome, Tourette syndrome, language dysfunction, and abnormal behavioral manifestations. Case presentation: A 10-years-old boy was referred to the hospital with mild intellectual disability and language impairment. Moreover, the child exhibited minor facial features, epileptic seizures, and notable behavioral abnormalities including impulsivity, aggressivity, and hyperactivity suggestive of the diagnosis of disruptive, impulse-control and conduct disorder (CD). Array comparative genomic hybridization (CGH) revealed a copy number variant (CNV) deletion in the first intron of CNTNAP2 gene inherited from a healthy father. Conclusions: A comprehensive description of the phenotypic features of the child is provided, revealing a distinct and remarkable alteration of social behavior not previously reported in individuals affected by disorders related to CNTNAP2 gene disruptions. A possible causative link between the deletion of a non-coding regulatory region and the symptoms presented by the boy has been advanced.

Neuropsychological Subgroups of Emotion Processing in Youths With Conduct Disorder.

Background: At the group level, youths with conduct disorder (CD) show deficient emotion processing across various tasks compared to typically developing controls (TDC). But little is known about neuropsychological subgroups within the CD population, the clinical correlates of emotion processing deficits [for instance, with regard to the presence or absence of the DSM-5 Limited Prosocial Emotions (LPE) specifier], and associated risk factors. Methods: 542 children and adolescents with CD (317 girls) and 710 TDCs (479 girls), aged 9-18 years, were included from the FemNAT-CD multisite study. All participants completed three neuropsychological tasks assessing emotion recognition, emotion learning, and emotion regulation. We used a self-report measure of callous-unemotional traits to create a proxy for the LPE specifier. Results: Relative to TDCs, youths with CD as a group performed worse in all three emotion domains. But using clinically based cut-off scores, we found poor emotion recognition skills in only 23% of the participants with CD, followed by emotion regulation deficits in 18%, and emotion learning deficits in 13% of the CD group. Critically, the majority of youths with CD (~56%) did not demonstrate any meaningful neuropsychological deficit, and only a very small proportion showed pervasive deficits across all three domains (~1%). Further analyses indicate that established DSM-5 subtypes of CD are not tightly linked to neurocognitive deficits in one particular emotion domain over another (i.e., emotion recognition deficits in CD+LPE vs. emotion regulation deficits in CD-LPE). Conclusions: Findings from this large-scale data set suggest substantial neuropsychological diversity in emotion processing in the CD population and, consequently, only a subgroup of youths with CD are likely to benefit from additional behavioral interventions specifically targeting emotion processing mechanisms.

Comorbid disorders as moderators of response to family interventions among adolescents with bipolar disorder.

BACKGROUND: While family interventions have shown efficacy in improving mood symptoms and family functioning in pediatric bipolar disorder, few studies have examined the effects of comorbid psychiatric conditions on patients' symptomatic or functional responses to treatment. METHODS: 145 adolescents with bipolar I or II disorder were randomly assigned to family-focused therapy (FFT-A) or a brief psychoeducational therapy (enhanced care; EC) and followed over 2 years. Participants received pharmacotherapy for the study's duration. We examined whether comorbid anxiety disorders, attention-deficit/hyperactivity disorder (ADHD), and disruptive behavior disorders (DBDs; i.e., oppositional defiant and conduct disorder) predicted the proportion of weeks that participants experienced mood symptoms during follow-up, and whether comorbid disorders moderated the effects of treatment assignment on mood symptoms and family conflict. RESULTS: Comorbid anxiety was associated with a greater proportion of weeks with depressive symptoms, more severe (hypo)manic symptoms during follow-up, and greater family conflict over the 2-year study. Comorbid ADHD was associated with a greater proportion of weeks with (hypo)manic symptoms, more severe (hypo)manic symptoms, and greater family conflict. Additionally, youth with comorbid ADHD who received FFT-A had more favorable trajectories of (hypo)manic symptoms and family functioning than youth with comorbid ADHD who received EC. Comorbid DBDs were consistently associated with more severe depressive symptoms and greater family conflict throughout the study. LIMITATIONS: Randomization to treatments was not stratified on comorbid disorders. The longitudinal trajectories of anxiety, attentional, and disruptive behavior symptoms were not examined. CONCLUSIONS: The course of bipolar disorder in adolescents is strongly affected by comorbid disorders. Future research should examine whether adolescents with more complex presentations of bipolar disorder should be treated with different or more intensive psychosocial protocols than adolescents without these presentations.

Increased structural connectivity in corpus callosum in adolescent males with conduct disorder.

OBJECTIVE: Adolescents with conduct disorder (CD) are at high risk for developing adult antisocial personality disorder. However, the underlying neuropathophysiology of CD remains poorly understood. We hypothesized that the microstructure of white matter (WM) of males with CD may differ from that of healthy control subjects (HCs). METHOD: Tract-based spatial statistics (TBSS) and quantitative tractography were used to assess WM microstructural differences between 36 teenaged boys with CD and 33 demographically matched HCs. RESULTS: The CD group behavioral scale scores were significantly higher than those of the HCs on the Barratt Impulsivity Scale, the Strength and Difficulties Questionnaire, and the Antisocial Process Screening Device total scales. TBSS revealed that, relative to HCs, the CD group had higher fractional anisotropy (FA) in the corpus callosum (CC) region, bilaterally, including the genu and body of the CC, as well as in some projection fibers in the region of the left anterior coronal radiate and right superior coronal radiate. Tractography confirmed higher FA of fibers passing through the regions with significant differences in the TBSS results. Exploratory analysis revealed that impulsivity associated positively with the FA of these fibers in the CD group. CONCLUSIONS: Maturation of WM microstructure in CD subjects differed from that in HCs, mainly in the CC. The abnormal maturation of WM structures may play an important role in the impulsivity and aggression of teenagers with CD.

Atypical mismatch negativity to distressful voices associated with conduct disorder symptoms.

BACKGROUND: Although a general consensus holds that emotional reactivity in youth with conduct disorder (CD) symptoms arises as one of the main causes of successive aggression, it remains to be determined whether automatic emotional processing is altered in this population. METHODS: We measured auditory event-related potentials (ERP) in 20 young offenders and 20 controls, screened for DSM-IV criteria of CD and evaluated using the youth version of Hare Psychopathy Checklist (PCL:YV), State-Trait Anxiety Inventory (STAI) and Barrett Impulsiveness Scale (BIS-11). In an oddball design, sadly or fearfully spoken 'deviant' syllables were randomly presented within a train of emotionally neutral 'standard' syllables. RESULTS: In young offenders meeting with CD criteria, the ERP component mismatch negativity (MMN), presumed to reflect preattentive auditory change detection, was significantly stronger for fearful than sad syllables. No MMN differences for fearful versus sad syllables were observed in controls. Analyses of nonvocal deviants, matched spectrally with the fearful and sad sounds, supported our interpretation that the MMN abnormalities in juvenile offenders were related to the emotional content of sounds, instead of purely acoustic factors. Further, in the young offenders with CD symptoms, strong MMN amplitudes to fearful syllables were associated with high impulsive tendencies (PCL:YV, Factor 2). Higher trait and state anxiety, assessed by STAI, were positively correlated with P3a amplitudes to fearful and sad syllables, respectively. The differences in group-interaction MMN/P3a patterns to emotional syllables and nonvocal sounds could be speculated to suggest that there is a distinct processing route for preattentive processing of species-specific emotional information in human auditory cortices. CONCLUSIONS: Our results suggest that youths with CD symptoms may process distressful voices in an atypical fashion already at the preattentive level. This auditory processing abnormality correlated with increased impulsivity and anxiety. Our results may help to shed light on the neural mechanisms of aggression.

Validación concurrente para trastornos externalizados del MINI-Kid y la entrevista semiestructurada para adolescentes

Debido al incremento de la demanda de herramientas útiles y simples para la evaluación psiquiátrica de niños y de adolescentes, decidimos realizar un estudio de validación concurrente entre la Mini Entrevista Internacional Neuropsiquiátrica para Niños y Adolescentes (MINI-KID) y la Entrevista Semiestructurada para Adolescentes (ESA) para establecer la confiabilidad diagnóstica para los padecimientos externalizados: trastorno por déficit de atención con hiperactividad (TDAH), trastorno negativista y desafiante (TND) y trastorno disocial (TD). Entrevistadores experimentados evaluaron de forma completa a once pacientes con la ESA; posteriormente se re-evaluó a los adolescentes con la versión electrónica del MINI-KID por clínicos ciegos al resultado de la ESA. Para analizar el grado de acuerdo entre ambos instrumentos, se utilizó el coeficiente de correlación Kappa de Cohen. En nuestro estudio los valores de Kappa para TDAH y TND fueron considerados con buena y excelente confiabilidad (0.64 y 0.81), respectivamente. De acuerdo con nuestros resultados, la ESA pareciera ser un instrumento más sensible que el MINI lo cual es contrario a lo que reporta la literatura para este tipo de entrevistas. Sin embargo, se debe tomar en cuenta diversas limitaciones antes de establecer una conclusión sólida. Palabras Clave: Mini Entrevista Internacional Neuropsiquiátrica para Niños y Adolescentes (MINI-Kid), Entrevista Semiestructurada para Adolescentes (ESA), Trastorno por Déficit de Atención e Hiperactividad (TDAH), Trastorno Oposicionista Desafiante (TOD/TND), Trastorno de Conducta (TC).

In face of the increase of the demand for useful and simple tools to help in the psychiatric evaluation of children and adolescents, we decided to undertake this research, in which we analyzed the reliability between the Mini International Neuropsychiatric Interview (MINI-KID) and the Adolescents Semi-structured Interview (ASI) to establish the concurrent validity for the diagnosis for Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant disorder (ODD) and Conduct Disorder (CD). Trained interviewers exhaustively evaluated a total of eleven patients using the ASI, afterwards clinicians who were blind to the results with the ASI re-evaluated the individuals with the electronic version of the MINI-KID. In order to analyze the similarity between both instruments, we used the Cohen's Kappa correlation coefficient. The values obtained were good and excellent with a confidence index for ADHD and ODD (0.64 y 0.81), respectively. In accord with our results, the ASI seems to be a more sensitive instrument in comparison with the MINI, which contrasts with many findings in the literature about these instruments. Nevertheless, some limitations should be considered. Keywords: Mini International Neuropsychiatric Interview for Kids and Adolescents (MINI-Kid), Adolescents Semi-structured Interview (ASI), Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD).