Adult Antisocial Personality Disorder Research Articles

Attention deficit hyperactivity disorder (ADHD) syndrome across ages

AbstractAttention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that significantly impacts various aspects of life, including school, work, family, and social relationships. The disorder has a prevalence of 6–7% in children and 4–5% in adults and commonly manifests before the age of 12. Symptoms can be categorised into two groups: attention deficit; and hyperactivity/impulsivity. As individuals age, hyperactivity symptoms generally decrease, while attention deficit symptoms exhibit less change. Attention deficit hyperactivity disorder is associated with numerous adverse outcomes, such as comorbid psychiatric disorders, academic difficulties, accidents, injuries, and increased economic burdens on society and individuals. Children and adults with ADHD have a high rate of psychiatric comorbidity, including learning disorders, autism spectrum disorder, anxiety disorders, mood disorders, tic disorders, adolescent substance abuse, and antisocial personality disorder in adulthood. Timely detection, enhanced intervention strategies, and consistent care may alleviate the clinical and economic burden of ADHD.

Head Injury and Antisocial Personality Features in a Sample of Juvenile Detainees

Previous research has reported high prevalence rates of head injury amongst juvenile justice involved youth and relations between head injury and different forms of offending. However, little is currently known about the extent to which head injury is associated with antisocial personality features – characteristics that are strongly correlated with adult antisocial personality disorder symptomatology. The current study aimed to address this void in the existing body of research by analyzing a longitudinal sample of juvenile detainees ( N = 881) to examine the relationship between head injury during childhood or early adolescence and a wide range of antisocial personality features in late adolescence. Results from a series of logistic regression models reveal that head injury is associated with impulsivity and aggression more than other features of antisocial personality. The implications of these results for juvenile justice intervention programming and avenues for future research are discussed.

Assessment and Treatment of Childhood-Onset Conduct Disorder: A Literature Review

Introduction: Conduct disorder (CD) is among the most highly represented diagnostic issues in child psychiatry. Current research suggests that early-onset CD is predictive of a worse prognosis and trajectory than other CD subtypes if not subsequently met with appropriate psychological assessment and symptom management. This paper aims to provide an overview of the literature from 2014 to 2021 in assessment and intervention protocols that target childhood-onset type specific CD, and appraise associated barriers implicated by the findings. Methods: This review involved a thorough literature search in electronic databases to extract empirical studies directly related to childhood-onset CD. The review was performed on PsycINFO and PubMed using the following search words: “conduct disorder(s)” OR “CD” OR “conduct disordered”, AND “child(hood)-onset” OR “elementary-onset” OR “early-onset”, AND “assessment” OR “evaluation” OR “examination”, AND “intervention” OR “treatment” OR “symptom management”. Results: Based on trends, articles were sorted into three common topics: assessment, treatment, and barriers to psychological services. The studies demonstrated the importance of sensitive and specific assessment tools, neural measures, behavioural markers, and the limited prosocial emotions (LPE) specifier. The results indicated that comorbidities, tailored school- and family-based intervention, parent-child conflict, and the LPE specifier in addition to the age-of-onset subtype is an area of research for clinicians. Discussion: Research has shown that childhood-onset CD, compared to other age-of-onset subtypes, is associated with individual risk factors such as neurological and cognitive deficits, poor emotion regulation, familial maladaptive parenting styles, and evocative family instability. While research has focused on dispositional risk factors for this heterogenous disorder, it is important to shift the focus to evidence-based clinical assessment and treatment strategies tailored to the poor prognosis of this subtype. Future research should examine current assessment sensitivity and appraise key stakeholders in early identification and treatment. Conclusion: Early detection and intervention will increase the chances of a positive outcome for all parties, which includes reducing emotional strain and internalizing thoughts of caregivers and teachers and preventing antisocial personality disorder in adulthood. Normative treatment options for childhood-onset CD coincides with individual risk factors, further research will have implications in identifying and providing early care to at-risk children.

Predicting Antisocial Personality Features among Justice-Involved Males and Females: The Effects of Violence Exposure in Childhood and Adolescence

The high rate of antisocial personality disorder (ASPD) among individuals involved in the justice system represents a significant public health concern, as individuals with ASPD are more likely to reoffend after incarceration and to engage in longer-term offending behavior patterns over the lifespan. Research suggests that traumatic event exposure in childhood and adolescence may be one factor that contributes to the heightened risk for ASPD in adulthood, though findings are mixed depending on the operationalization of trauma exposure and demographics of study samples. The present study examined the impact of early and varied exposure to violence on the development of ASPD features in young adulthood. In addition, given evidence for gender differences in how youth respond to trauma, as well as disparate prevalence rates of ASPD among males and females, a secondary aim was to assess the impact of gender on the relationship between early trauma and antisocial personality outcomes. The study sample consisted of 1354 adolescents (86% male) who participated in a longitudinal research study of serious juvenile offenders. A series of linear regression analyses revealed that the magnitude of violence exposure participants endorsed at baseline significantly predicted antisocial personality features at six-year follow-up. Participants’ gender was not found to moderate the relationship between violence exposure and antisocial outcomes. Results suggest that targeting maladaptive cognitions and behaviors resulting from chronic exposure to early trauma may be a crucial component of treatment for justice-involved individuals exhibiting ASPD features.

Exploring the Effects of Early Trauma in a Forensic High Secure Population: Evaluating Associations Between Adverse Childhood Experiences (ACEs) and Diagnosis of Antisocial Personality Disorder (ASPD)

AimsTo examine links between Adverse Childhood Experiences (ACE) categories and diagnosis of antisocial personality disorder (ASPD) in this population; it is predicted that there will be a positive association between number of ACEs and ASPD. The effectiveness of high secure hospital admission and treatment in reducing number of risk incidents was also examined. ACEs are known to impact significantly on the development of the personality and future psychiatric risk. Currently, research into links between distinct ACE categories and the diagnosis of ASPD in the high-secure inpatient population is limited.MethodsData were collected from a sample (n = 221) including all patients in the Mental Health, Personality Disorder and Women's Services at a high-secure hospital. Records were examined for evidence of abuse/neglect during childhood, and a number of markers of household dysfunction. The statistical relationship between each ACE category and subsequent diagnosis of ASPD was examined through paired t-tests. Frequency of incident reports (IR1s) involving violence was compared in the first, third and fifth years post-admission.ResultsSignificant associations with adult diagnosis of ASPD were seen in categories of childhood physical abuse, sexual abuse, divorced/separated parents, Looked After Child (LAC) status and parental substance misuse, and total number of ACE categories present overall. Significant reductions in frequency of IR1s were seen in all services between first- and fifth- year post admission.ConclusionA significant association between ACEs in specific domains and ASPD in adulthood was found. The importance of detailed exploration of childhood circumstances in this group is highlighted, as well as the need for further investigation of the psychological and social mechanisms underlying.

The clinical course of antisocial behaviors in men and women of three racial groups

AimsTo describe the clinical course and symptom profile of DSM-IV Antisocial Personality Disorder (ASPD) and the syndrome of Adult Antisocial Behavior Syndrome (AABS) and determine if they differ based on sex and race. MethodsUsing questions from a validated semi-structured interview, data were gathered from 2 independent family studies in: 1) American Indians (AI), and 2) European Americans (EA), African Americans (AA) (total n = 7171) who reported antisocial symptoms. ResultsWithin these two samples 1148 (16%) individuals met ASPD criteria, 1932 (27%) met adult ASPD but not childhood conduct disorder (CD) (i.e., AABS). The clinical course of the antisocial behaviors studied did not differ based on race or sex; however, individual symptom counts, and age of onsets of those symptoms, were significantly different across the groups. Women reported fewer symptoms and at an older age (less fights, school suspensions/expulsions, arrests or jail time), than men but were more likely to run away from home. Those with ASPD vs. AABS had more symptoms overall including not experiencing remorse. AA and AI participants and those with ASPD, had more symptoms, and were more likely to be suspended/expelled from school and arrested at a younger age than EA. ConclusionIn these select samples, the order and sequence of antisocial behaviors did not differ by race, AASB vs. ASPD, or sex; however individual symptom endorsement did, with men (vs. women), those with ASPD (vs. AABS), AI and AA (vs. EA) reporting more suspensions/expulsions from school and arrests. This suggests further study of the possible role of race and sex in the consequences associated with antisocial syndromes is warranted.

Executive functions as a mediator of childhood maltreatment on adult psychopathology: A longitudinal mediation analysis comparing maltreatment factor models

BackgroundChildhood maltreatment (CM), executive functions (EFs), and psychiatric disorders all correlate highly. Changes in EFs during adolescence related to CM present a possible mediating mechanism for the development of psychiatric disorders, yet no study has analyzed this longitudinally while comparing predictive capacity of different CM factor structures. We hypothesized that changes in EFs from adolescence to adulthood would mediate, in part, associations between CM, internalizing disorders (INT), and anti-social personality disorder (ASPD) while different subtypes of CM would differentially predict INT and ASPD. ObjectiveThis study longitudinally examined the mediating effects of EFs on associations between CM, INT, and ASPD while comparing prediction of two CM factor structures. ParticipantsHigh-risk subjects selected for drug use in adolescence (N = 658) from mean ages 16 to 23. MethodsA Bayesian structural equation model was deployed to analyze change in EFs as a mediator of the relationship between CM and adult INT and ASPD. CM was measured using two factor structures: a single overall factor and four correlated factors representing CM subtypes. ResultsCM significantly predicted INT and ASPD but there was no evidence that the relationship was substantially mediated through EFs. High correlations among subtypes of CM limited the unique predictions of each subtype on INT and ASPD. ConclusionIn this high-risk sample, the collinearity of CM subtypes obscured their predictions of outcome measures supporting the use of one CM factor. EFs did not significantly mediate associations between CM and psychiatric disorders, but further research on these relationships is warranted.

Latent triple trajectories of substance use as predictors for the onset of antisocial personality disorder among urban African American and Puerto Rican adults: A 22-year longitudinal study

Background Antisocial personality disorder (ASPD) incurs a high cost to society due to the high risk of violent and nonviolent offenses associated with this personality disorder, thus making the examination of the etiology and the onset of ASPD an important public health concern. Method: The present study consisted of five waves of data collection of the Harlem Longitudinal Development Study (N = 674). In the Cox proportional hazard model, latent multiple substance use trajectories from mid-adolescence to emerging adulthood (mean age 14 to mean age 24) were used as a predictor for the onset of ASPD during emerging adulthood to the mid-thirties (mean age 24 to mean age 36). The control variables were gender, ethnicity, problem behaviors, and victimization. Results: In the multiple Cox proportional hazard model, the high (HR = 2.74, p < 0.001) and the increasing frequency of (HR = 2.55, p < 0.001) use on alcohol, cigarette, and cannabis latent trajectory groups were associated with an increased hazard of ASPD onset as compared with the no or low frequency of use on alcohol, cigarette, and cannabis latent trajectory group after controlling for demographic factors and earlier problem behaviors as well as victimization. Conclusions: The implications of this study for the prediction of adult ASPD onset time may focus on the early use of alcohol, cigarette, and cannabis from mid adolescence to emerging adulthood.

Association between childhood trauma, parental bonding and antisocial personality disorder in adulthood: A machine learning approach

Childhood trauma (CT) and parental bonding (PB) have been correlated with later antisocial personality disorder (ASPD). Aiming to better understand this complex interaction we analyzed the data from a cross-sectional study that evaluated 346 male inpatient cocaine users, using both traditional statistical analysis and machine learning (ML) approaches. Childhood Trauma Questionnaire (CTQ), Parental Bonding Instrument (PBI), and Mini International Neuropsychiatric Interview (MINI) were applied. We found a markedly higher prevalence of mental illness in the ASPD group. The ML method and the traditional analysis showed that emotional and physical abuse were the factors with the strongest relationship with ASPD. Also, there were discrepancies between the findings of both methods regarding physical neglect and paternal care. Although this study does not allow definitive answers in this matter, we do propose that these two methods can aid in better comprehending how multiple variables interact with each other in the development of psychological disorders.

Adult Retrospective Reports of Externalizing Behavior: Distinct Dimensions and Key Associations for Past Conduct Disorder Ratings

Many studies have examined the correlates and factor structure of the conduct disorder (CD) criteria in child and adolescent samples, finding that the set of behaviors defining CD are heterogeneous in nature. However, the factor structure of the CD criteria has not been examined in adults, even though the CD criteria often must be assessed retrospectively when diagnosing antisocial personality disorder (ASPD) in adulthood. To advance understanding of assessing CD behaviors retrospectively in adults, we present factor analytic and correlational results from a large sample of adult outpatients (N = 1793). Our results indicate that CD ratings are defined by at least two latent factors of Rule Violation (e.g., curfew violations) and Aggression (e.g., using a weapon). Ratings of aggressive behaviors tended to show somewhat stronger associations with other externalizing psychopathology than did rule violation ratings. Furthermore, CD dimensions identified in our factor analyses correlated robustly with ASPD but correlated just as strongly with diagnostic ratings of other externalizing psychopathology such as substance use history. We discuss how these findings from a large adult sample parallel results from child and adolescent samples indicating that the CD criteria are defined by distinct dimensions. Furthermore, we interpret these findings within the context of other recent studies suggesting that a CD history may not be a specific precursor to ASPD in adulthood.

Chapter 25 - Sex differences in antisocial and aggressive disorders that onset in childhood and persist into adulthood

As many as 10.7% of males and 7.5% of females display early-onset, stable, antisocial and aggressive behavior (ESAAB). Most research has focused on males. These individuals are diagnosed with conduct disorder in childhood and antisocial personality disorder in adulthood, and a very few, almost all males, present the syndrome of psychopathy. ESAAB includes three subgroups: (1) conduct problems and callousness; (2) conduct problems, callousness, and anxiety; and (3) conduct problems. Heritability of the first two subtypes is high. This high heritability derives, at least in part, from genes involved in regulating serotonergic functioning early in life and to genotypes that confer sensitivity to trauma. The first subtype is rare and characterized by difficulty in face emotion recognition, especially fear and sadness, and hypoarousal as indexed by both autonomic and neural measures, and by structural brain abnormalities. By contrast, those with conduct problems, callousness, and anxiety are more common. They include a greater proportion of females and show hypersensitivity to threat that triggers reactive aggression and that is reflected in both autonomic and neural functioning. In sum, fewer females than males present ESAAB, but many characteristics, autonomic and neural correlates, and etiology are similar. Importantly, however, females with ESAAB play a critical role in the intergenerational transfer of antisocial behavior. Despite higher prevalence of EASSB in males than females, few sex differences in neural abnormalities have been identified.

Effects of Childhood and Adult Persistent Attention-Deficit/Hyperactivity Disorder on Risk of Motor Vehicle Crashes: Results From the Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder

To determine motor vehicle crash (MVC) risk in adults with a history of childhood attention-deficit/hyperactivity disorder (ADHD) and persistent ADHD symptoms. Participants with (n= 441) and without (n= 239; local normative comparison group) childhood ADHD from the Multimodal Treatment of Attention-Deficit/Hyperactivity Disorder (MTA) Study were included. Participants provided self-reports on total number of MVCs they had been involved in and the time of licensure. Driving experience was estimated as the number of months since licensure. Total number of MVCs by adulthood was regressed on baseline ADHD status adjusting for sex, age at follow-up, driving experience, baseline oppositional defiant disorder/conduct disorder comorbidity, baseline household income level, adult oppositional defiant disorder/conduct disorder symptoms, adolescent and adult substance use, and adult antisocial personality disorder symptoms. We repeated the analysis using adult ADHD status (persistent versus desistant versus local normative comparison group) and symptom level as the predictor variables. Results are presented as incidence rate ratio (IRR) and CI. Childhood ADHD was associated with a higher number of MVCs (IRR= 1.45, CI= 1.15-1.82), and adult ADHD symptom persistence was associated with more MVCs than desistance (IRR= 1.46, CI= 1.14-1.86). ADHD desistance was not associated with a significantly increased risk for MVCs compared with the local normative comparison group (IRR= 1.24, CI= 0.96-1.61). Concurrent symptoms of inattention and hyperactivity/impulsivity predicted MVC risk. Persistence of ADHD into adulthood is a stronger predictor of MVC risk than childhood-limited ADHD. Multimodal Treatment of Attention Deficit Hyperactivity Disorder (MTA) Study; https://clinicaltrials.gov; NCT00000388.

Do adult males with antisocial personality disorder (with and without co-morbid psychopathy) have deficits in emotion processing and empathy? A systematic review

Abstract Background A lack of concern for the feelings, needs or suffering of others and lack of remorse after hurting or mistreating others are key characteristics of antisocial personality disorder (ASPD), otherwise identified as dissocial personality disorder (DPD) and suggest that impaired emotion processing and empathy may contribute to antisocial behaviour. Whilst psychopathy is more commonly associated with an absence of empathy and emotional affect, the nature of emotion processing and empathy deficits specific to adult male ASPD populations with and without co-morbid psychopathy has not been systematically reviewed. Aim To determine the nature of emotion processing and empathy deficits specific to adult male ASPD populations with and without co-morbid psychopathy. Method We conducted a literature search across seven electronic databases and a range of grey literature sites, hand-searched reference lists of relevant papers and contacted fourteen authors of published studies related to this topic. Inclusion and exclusion criteria were applied and quality assessments undertaken on eligible studies. Results Searches located 10,217 records and 205 were eligible for full assessment. 22 studies were identified as suitable for inclusion in this review and 19 reported evidence of emotion processing deficits in ASPD/DPD groups with and without co-morbid psychopathy. Conclusion This review found no evidence of empathy deficits in ASPD/DPD groups with or without co-morbid psychopathy and only limited evidence of diminished startle reactivity in those with ASPD alone. In contrast, ASPD groups with co-morbid psychopathy were found to exhibit aberrant patterns of affective reactivity and difficulty when processing negative/aversive stimuli which lends support to the notion that these groups may be differentiated in terms of emotional dysfunction. However, as the majority of reviewed studies employed ASPD/DPD groups that included participants with co-morbid psychopathy/psychopathic traits and did not delineate effects for ASPD/DPD groups with and without co-morbid psychopathy, the degree to which emotion processing deficits were mediated by co-morbid psychopathy or evident in ASPD/DPD alone could not be established. Therefore, further research to compare emotion processing and empathy in these groups is required before firm conclusions can be drawn about the extent of overlap between these populations and/or the differences that exist between them.

Conduct disorder.

Conduct disorder (CD) is a common and highly impairing psychiatric disorder that usually emerges in childhood or adolescence and is characterized by severe antisocial and aggressive behaviour. It frequently co-occurs with attention-deficit/hyperactivity disorder (ADHD) and often leads to antisocial personality disorder in adulthood. CD affects ~3% of school-aged children and is twice as prevalent in males than in females. This disorder can be subtyped according to age at onset (childhood-onset versus adolescent-onset) and the presence or absence of callous-unemotional traits (deficits in empathy and guilt). The aetiology of CD is complex, with contributions of both genetic and environmental risk factors and different forms of interplay among the two (gene-environment interaction and correlation). In addition, CD is associated with neurocognitive impairments; smaller grey matter volume in limbic regions such as the amygdala, insula and orbitofrontal cortex, and functional abnormalities in overlapping brain circuits responsible for emotion processing, emotion regulation and reinforcement-based decision-making have been reported. Lower hypothalamic-pituitary-adrenal axis and autonomic reactivity to stress has also been reported. Management of CD primarily involves parent-based or family-based psychosocial interventions, although stimulants and atypical antipsychotics are sometimes used, especially in individuals with comorbid ADHD.

Indirect Effects of Early Parenting on Adult Antisocial Outcomes via Adolescent Conduct Disorder Symptoms and Callous-Unemotional Traits

Parental harsh punishment and warmth have been associated with child and adolescent conduct disorder (CD) symptoms and callous-unemotional (CU) traits (i.e., lack of guilt, empathy, and deficient affect); however, it is unclear whether the effect of these parenting behaviors on antisocial outcomes persists into adulthood. Thus, the present study aimed to test whether adolescent CD symptoms and CU traits mediate the effect of parental harsh punishment and warmth on adult antisocial outcomes (i.e., antisocial personality disorder (ASPD), externalizing psychopathology, partner violence, and violent and substance crime). Participants included the high-risk control and normative samples from the Fast Track project (N =753, male = 58%, African American = 46%). Harsh punishment during kindergarten through grades 1–2 predicted higher adolescent CD symptoms, and directly observed warmth during kindergarten through grades 1–2 predicted lower adolescent CU traits. Adolescent CD symptoms predicted greater adult substance crime, and adolescent CU traits predicted greater adult ASPD symptoms and externalizing psychopathology. Further, adolescent CD symptoms indirectly accounted for the effect of parental harsh punishment on adult substance crime, and adolescent CU traits indirectly accounted for the effect of parental warmth on ASPD symptoms and externalizing psychopathology. Findings support the importance of early interventions targeting parenting behaviors to reduce risk for the development of antisocial behavior, and inform developmental models of antisocial behavior in adolescence through adulthood.

Post-traumatic stress disorder and having antisocial peers in adolescence are risk factors for the development of antisocial personality disorder

Antisocial personality disorder is a mental illness that is a major public health concern. Both post-traumatic stress disorder and association with antisocial peers have been found to be associated with increased risk for diagnosis of antisocial personality disorder. Despite this, past research has yet to examine the interrelatedness of these three constructs from a developmental perspective. This study sought to examine the effect of post-traumatic stress disorder in adolescence on the risk for antisocial personality disorder diagnosis in adulthood and the relevance of differences in developmental patterns of degree of association with antisocial peers in adolescence as an additional risk factor. The Pathways to Desistance data were used in analyses, comprising the longitudinal responses of 1,354 juvenile offenders who had recently been adjudicated for a serious offense prior to baseline measurement. Logistic regression was used to examine these relationships. Ever meeting criteria for post-traumatic stress disorder in adolescence significantly increased the odds of developing antisocial personality disorder in adulthood. This effect was no longer significant upon inclusion of variables pertaining to association with antisocial peers. Implications are discussed.

Childhood serotonergic function and early adult outcomes in youth with ADHD: A 15-year follow-up study

Longitudinal studies have shown that clinical precursors of antisocial personality disorder (ASPD) include attention-deficit/hyperactivity disorder (ADHD) and more notably comorbid ADHD and conduct disorder (CD). Despite existing evidence for the purported role of abnormal serotonergic function in aggressive youth and adults, little evidence exists on the role of serotonin in the progression from childhood disruptive behavior disorders to adult psychopathology, including ASPD. This study examined the relation between serotonergic function in children diagnosed with ADHD and the development of ASPD in early adulthood. We hypothesized that low serotonin response to a pharmacological probe in childhood would predict the development of adult ASPD. Towards this goal we divided 40 adults (M = 37, F = 3), ages 23–26 (m-24.57, sd-2.33) diagnosed with childhood ADHD into 2 groups: participants with (n = 21) and without (n = 19) ASPD. We used logistic regression to assess whether serotonergic measures in childhood assessed via prolactin and cortisol responses to a fenfluramine challenge, would selectively predict the development of ASPD in early adulthood. Logistic regression models showed that low central serotonergic response in childhood indexed by cortisol response significantly predicted adult ASPD (Wald = 4.427, p = .035) but not ADHD diagnosis in adulthood. Adults without ASPD had the highest serotonergic response whereas adults with adolescent ASPD (i.e. early onset ASPD) had the lowest response. Thus we provide new evidence of the link between low serotonergic function in childhood and the development of ASPD in adulthood, particularly for boys with adolescent onset of ASPD. These findings are relevant for understanding the contribution of childhood neurobiology to risk for later ASPD.

Predictors of adult outcomes in clinically- and legally-ascertained youth with externalizing problems.

Externalizing problems (EP), including rule-breaking, aggression, and criminal involvement, are highly prevalent during adolescence, but the adult outcomes of adolescents exhibiting EP are characterized by heterogeneity. Although many youths’ EP subside after adolescence, others’ persists into adulthood. Characterizing the development of severe EP is essential to prevention and intervention efforts. Multiple predictors of adult antisocial personality disorder (ASPD) and legal outcomes of a large sample (N = 1205) of clinically- or legally-ascertained adolescents (ages 12–19 years) with severe EP were examined. Many psychosocial predictors hypothesized to predict persistence of EP demonstrated zero-order associations with adult outcomes, but accounted for little unique variation after accounting for baseline conduct disorder symptoms (CD) and demographic factors. Baseline measures of intelligence, which explained independent variation in legal outcomes, provided the only consistent exception to this pattern, though future work is needed to parse these effects from those of socioeconomic factors. CD severity during adolescence is a parsimonious index of liability for persistence of EP into adulthood that explains outcome variance above and beyond all other demographic and psychosocial predictors in this sample.

Adult outcomes of childhood disruptive disorders in offspring of depressed and healthy parents

BackgroundLongitudinal studies of children with disruptive disorders (DDs) have shown high rates of antisocial personality disorder (ASPD) and substance use in adulthood, but few have examined the contribution of parental disorders. We examine child-/adulthood outcomes of DDs in offspring, whose biological parents did not have a history of ASPD, bipolar disorder, or substance use disorders. MethodOffspring (N = 267) of parents with or without major depression (MDD), but no ASPD or bipolar disorders were followed longitudinally over 33 years, and associations between DDs and psychiatric and functional outcomes were tested. ResultsEighty-nine (33%) offspring had a DD. Those with, compared to without DDs, had higher rates of MDD (adjusted odds ratio, AOR = 3.42, p < 0.0001), bipolar disorder (AOR = 3.10, p = 0.03), and substance use disorders (AOR = 5.69, p < 0.0001) by age 18, as well as poorer school performance and global functioning. DDs continued to predict MDD and substance use outcomes in adulthood, even after accounting for presence of the corresponding disorder in childhood (MDD: hazards ratio, HR = 3.25, p < 0.0001; SUD, HR = 2.52, p < 0.0001). Associations were similar among the offspring of parents with and without major depression. DDs did not predict adulthood ASPD in either group. LimitationsAssociations are largely accounted for by conduct disorder (CD), as there were few offspring with ADHD, and oppositional defiant disorder (ODD) was not diagnosed at the time this study began. ConclusionIf there is no familial risk for ASPD, bipolar disorder or substance use, childhood DDs do not lead to ASPD in adulthood; however, the children still have poorer prognosis into midlife. Early treatment of children with DD, particularly CD, while carefully considering familial risk for these disorders, may help mitigate later adversity.

A Psychometric Evaluation of the DSM-IV Criteria for Antisocial Personality Disorder: Dimensionality, Local Reliability, and Differential Item Functioning Across Gender.

This study aims at evaluating the psychometric properties of the antisocial personality disorder (ASPD) criteria in a large sample of patients, most of whom had one or more personality disorders (PD). PD diagnoses were assessed by experienced clinicians using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Axis II PDs. Analyses were performed within an item response theory framework. Results of the analyses indicated that ASPD is a unidimensional construct that can be measured reliably at the upper range of the latent trait scale. Differential item functioning across gender was restricted to two criteria and had little impact on the latent ASPD trait level. Patients fulfilling both the adult ASPD criteria and the conduct disorder criteria had similar latent trait distributions as patients fulfilling only the adult ASPD criteria. Overall, the ASPD items fit the purpose of a diagnostic instrument well, that is, distinguishing patients with moderate from those with high antisocial personality scores.