Criteria For Conduct Disorder Research Articles

Inventory of Callous-Unemotional Traits (ICU) Factor Structure and Measurement Invariance in an Adolescent Multinational Sample

ABSTRACT Objective The Inventory of Callous-Unemotional Traits (ICU) is a widely used, comprehensive measure of callous-unemotional (CU) traits. While the ICU total score is used frequently in research, the scale’s factor structure remains highly debated. Inconsistencies in past factor structure research appear to be largely due to the use of small non-representative samples and failure to control for method variance (i.e., item wording direction). Method The current study used a multitrait-multimethod (MTMM) confirmatory factor analysis (CFA) approach that considers both trait and method variance to test the factor structure of a 22-item version of the self-report ICU in a multinational community sample of 4,683 adolescents (ages 11–17). Results Results showed that a hierarchical four-factor model (i.e., one overarching CU factor, four latent trait factors) that controlled for method variance (i.e., by allowing residuals from positively worded items to covary) provided the best fit (χ2 = 2797.307, df = 160, RMSEA=.059, CFI=.922, TLI=.888, SRMR=.045). Conclusions After controlling for method variance, the best-fitting factor structure is consistent with how the ICU was developed and corresponds to the four symptoms of Limited Prosocial Emotions (LPE) specifier in the DSM-5 criteria for Conduct Disorder (CD). In addition, measurement invariance of this factor structure across age (i.e., younger versus older adolescents) and sex was supported. As a result, mean differences in ICU total score across age and sex can be interpreted as reflecting true variations in these traits. Further, we documented that boys generally scored higher than girls on the ICU, and this sex difference was larger in later adolescence.

More is more: Evidence for the incremental value of the SCID-II/SCID-5-PD specific factors over and above a general personality disorder factor.

Currently, 3 competing conceptualizations of personality dysfunction can be distinguished: the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) categorical model delineating 10 distinct types of personality disorders (PDs); the alternative model for PDs (DSM-5 Section III), which assesses personality functioning and traits separately; and the International Classification of Diseases, 11th Version conceptualization, which provides 1 single code for the presence of a PD (which is based on problems in functioning) as well as codes that specify the level of the disorder (mild/moderate/severe), and prominent trait domains or patterns (5 domains and 1 pattern). The current study aims to assess the incremental value of the DSM-5 PDs over and above a global personality dysfunction factor, using expert ratings obtained with the Structured Clinical Interview for DSM-IV PDs and the Structured Clinical Interview for DSM-5 PDs interview in a large sample of clinical patients (N = 3,851). All estimated bifactor models provided adequate fit to the data. We found a surprisingly low explained common variance for the g-factor (<40%), indicating that ignoring the specific PD factors would lead to a substantial loss of information. The strongest specific PDs in terms of explained common variance were the avoidant, schizotypal, and schizoid PD factors and the conduct disorder criteria set if included. Correlations between our factors and external variables were relatively low, except for the Severity Indices of Personality Problems, which aims to measure personality functioning. Our findings suggest that specific PDs still have an important role to play in the assessment of personality pathology. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Do Childhood Conduct Problems Predict Negative Outcomes in Adolescence? A Longitudinal Analysis

The primary purpose of this study was to conduct a prospective ­­­examination of the relationship between childhood conduct problems and five outcomes in adolescence– namely, Physically violent offenses; Non-violent offenses; Deviant lifestyle; Consumption of tobacco, cannabis, or alcohol; and Meeting the symptom count diagnostic criteria for Conduct Disorder (CD) – while controlling for a series of sociodemographic factors, family characteristics and adolescent experiences. Logistic regression analyses were used to determine if childhood conduct problems in the Canadian National Longitudinal Survey of Children and Youth (NLSCY) Cycle 1 contributed to negative outcomes in adolescence in NLSCY Cycle 4. This was a prospective, population-based study of 3,725 adolescents (12-15 years old) in the NLSCY Cycle 4 (2000-2001) who were 6-9 years old in NLSCY Cycle 1 (1994-95). Childhood conduct problems were found to be associated with Non-violent offenses and Consumption of tobacco, cannabis, or alcohol in adolescence, but they were not found to be associated with Physically violent offenses or Deviant lifestyle in adolescence. Furthermore, children with conduct problems before the age of 10 were more likely to meet the symptom count diagnostic criteria for CD in adolescence.&#x0D;

Psychometric Properties of a Semistructured Interview to Assess Limited Prosocial Emotions

Callous-unemotional (CU) traits have recently been added to the diagnostic criteria of Conduct Disorder in the Diagnostic and Statistical Manual of Mental Disorders-Fifth edition and of conduct-dissocial and oppositional defiant disorders in the International Classification of Disease-Eleventh edition as the limited prosocial emotions specifier. This change necessitates the assessment of these traits with validated measures in both research and clinical contexts. The current study sought to validate a semi-structured diagnostic interview method, the Michigan Limited Prosocial Emotion Addendum (M-LPE) to the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version, of assessing CU traits based on a recently developed clinician rating system (Clinical Assessment of Prosocial Emotions, Version 1.1) in a sample of at-risk youth. Results supported the interrater reliability of the M-LPE with moderate agreement and high reliability between raters. The M-LPE demonstrated convergent and incremental validity with CU traits and various measures of antisocial behavior. The results provide preliminary evidence for the use of a semi-structured interview assessment of CU traits in research contexts and build the foundation for further validation.

GRM8 genotype is associated with externalizing disorders and greater inter-trial variability in brain activation during a response inhibition task

ObjectiveThe present investigation tested the association of a novel measure of brain activation recorded during a simple motor inhibition task with a GRM8 genetic locus implicated in risk for substance dependence. Methods122 European-American adults were genotyped at rs1361995 and evaluated against DSM-IV criteria for Alcohol Dependence, Cocaine Dependence, Conduct Disorder, and Antisocial Personality Disorder. Also, their brain activity was recorded in response to rare, so-called “No-Go” stimuli presented during a continuous performance test. Brain activity was quantified with two indices: (1) the amplitude of the No-Go P300 electroencephalographic response averaged across trials; and (2) the inter-trial variability of the response. ResultsThe absence of the minor allele at the candidate locus was associated with all of the evaluated diagnoses. In comparison to minor allele carriers, major allele homozygotes also demonstrated increased inter-trial variability in No-Go P300 response amplitude but no difference in average amplitude. ConclusionsGRM8 genotype is associated with Alcohol and Cocaine Dependence as well as personality risk factors for dependence. The association may be mediated through an inherited instability in brain function that affects cognitive control. SignificanceThe present study focuses on a metric and brain mechanism not typically considered or theorized in studies of patients with substance use disorders.

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.

Clinical Characteristics of Patients with Antisocial Personality Disorder According to the Crime Types

We aimed to evaluate the relation between the crimes committed, and the childhood behavioral problems, current clinical characteristics and anger levels of patients with antisocial personality disorder (ASPD). One hundred and fifty-three patients with ASPD were enrolled. The diagnosis was made according to the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria. DSM-IV conduct disorder criteria and life history inventory was used to assess childhood characteristics. The State-Trait Anger Scale (STAS) was used to assess experience, expression, and control of anger. The main differences between crime groups were as follows: A head trauma history was more frequent in ASPD patients who had a crime history of physical assault. Loss of a parent in childhood was more frequent in individuals who committed burglary. Divorce or separation of the parents in childhood was more frequent in those who committed murder. The usage of weapons in fight during childhood was significantly higher in those who committed murder and aggravated assault. According to STAS scores, the anger control scores were significantly lower in those who committed murder. Childhood and behavioral characteristics of ASPD patients is not homogenous. There is a need for further studies to demonstrate these differences and make a new classification for ASPD.

Using self-reported callous-unemotional traits to cross-nationally assess the DSM-5 'With Limited Prosocial Emotions' specifier.

The presence of callous-unemotional (CU) traits designates an important subgroup of antisocial youth at risk for severe, persistent, and impairing conduct problems. As a result, the fifth revision of the Diagnostic and Statistical Manual includes a specifier for youth meeting diagnostic criteria for Conduct Disorder who show elevated CU traits. The current study evaluated the DSM-5 criteria using Item Response Theory (IRT) analyses and evaluated two methods for using a self-report measure of CU traits to make this diagnosis. The sample included 2257 adolescent (M age = 15.64, SD = 1.69 years) boys (53%) and girls (47%) from community and incarcerated settings in the United States and the European countries of Belgium, Germany, and Cyprus. IRT analyses suggested that four- or eight-item sets from the self-report measure (comparable to the symptoms used by the DSM-5 specifier) provided good model fit, suggesting that they assess a single underlying CU construct. Further, the most stringent method of scoring the self-report scale (i.e. taking only the most extreme responses) to approximate symptom presence provided the best discrimination in IRT analyses, showed reasonable prevalence rates of the specifier, and designated community adolescents who were highly antisocial, whereas the less stringent method best discriminated detained youth. Refined self-report scales developed on the basis of IRT findings provided good assessments of most of the symptoms used in the DSM-5 criteria. These scales may be used as one component of a multimethod assessment of the 'With Limited Prosocial Emotions' specifier for Conduct Disorder.

Selective Attention to Negative than Positive Emotions as Determinant of Delinquency in Youth in Pakistan

This experimental study is the first in Pakistan to focus delinquents and non-delinquents’ youth with an assumption both groups will show differences in the emotion recognition ability especially for negative than positive emotions. Experimental group comprised 50 juvenile delinquents drawn from one prison in Lahore 50 nondelinquents; confirmed as per conduct disorder criteria of DSM-IVTR (2000); 50 adolescents not confirming delinquency criteria was drawn from four public schools as control group. Age range of the sample was 14-17 years (M=15.5, SD=1.30). Measures used were Urdu version of an experimental task Facially Expressed Emotion Labeling (FEEL; Kessler, Traue, Bayerl & Hoffman, 2002) and a semi- structured interview form to obtain in depth information. The result of 2 x 6 Factorial ANOVA indicated non-significant difference across delinquents and nondelinquents groups however significant within subjects main effect for emotions and interaction of emotions with groups. Juvenile delinquents’ accuracy score on FEEL task was high on negative emotions (anger and fear) than non-delinquents who scored high on positive emotions (happiness and surprise). Most of the subjects of experimental group met the criteria of delinquency (n=43).The findings are discussed in the light of existing literature and Pakistani cultural context.

Exposure to maternal pre- and postnatal depression and anxiety symptoms: Risk for major depression, anxiety disorders, and conduct disorder in adolescent offspring

This study evaluated whether exposure to maternal pre- or postnatal depression or anxiety symptoms predicted psychopathology in adolescent offspring. Growth mixture modeling was used to identify trajectories of pre- and postnatal depression and anxiety symptoms in 577 women of low socioeconomic status selected from a prenatal clinic. Logistic regression models indicated that maternal pre- and postnatal depression trajectory exposure was not associated with offspring major depression, anxiety, or conduct disorder, but exposure to the high depression trajectory was associated with lower anxiety symptoms in males. Exposure to medium and high pre- and postnatal anxiety was associated with the risk of conduct disorder among offspring. Male offspring exposed to medium and high pre- and postnatal anxiety had higher odds of conduct disorder than did males with low exposure levels. Females exposed to medium or high pre- and postnatal anxiety were less likely to meet conduct disorder criteria than were females with lower exposure. To the best of our knowledge, this is the first study to examine the effect of pre- and postnatal anxiety trajectories on the risk of conduct disorder in offspring. These results suggest new directions for investigating the etiology of conduct disorder with a novel target for intervention.

Development and psychometric properties of the health-risk behavior inventory for Chinese adolescents.

BackgroundThere is a growing body of research investigating adolescent risk behaviors in China, however, a comprehensive measure that evaluates the full spectrum of relevant risk behaviors is lacking. In order to address this important gap, the current study sought to develop and validate a comprehensive tool: the Health-Risk Behavior Inventory for Chinese Adolescents (HBICA).MethodsAdolescents, ages 14–19 years (n = 6,633), were recruited from high schools across 10 cities in mainland China. In addition, a clinical sample, which included 326 adolescents meeting DSM-IV criteria for Conduct Disorder, was used to evaluate predictive validity of the HBICA. Psychometric properties including internal consistency (Cronbach’s alpha), test-retest reliability, convergent validity, and predictive validity were analyzed.ResultsBased upon item analysis and exploratory factor analysis, we retained 33 items, and 5 factors explained 51.75% of the total variance: Suicide and Self-Injurious Behaviors (SS), Aggression and Violence (AV), Rule Breaking (RB), Substance Use (SU), and Unprotected Sex (US). Cronbach’s alphas were good, from 0.77 (RB) to 0.86 (US) for boys, and from 0.74 (SD) to 0.83(SS) for girls. The 8 weeks test–retest reliabilities were moderate, ranged from 0.66 (AV) to 0.76 (SD). External validities was strong, with Barratt Impulsiveness Scale-11 was 0.35 (p < 0.01), and with aggressive behavior and rule-breaking behavior subscales of the Youth Self Report were 0.54 (p < 0.01) and 0.68 (p < 0.01), respectively. Predictive validity analysis also provided enough discriminantity, which can distinguish high risky individual effectively (cohen’ d = 0.79 – 2.96).ConclusionsThese results provide initial support for the reliability and validity of the Health-Risk Behavior Inventory for Chinese Adolescents (HBICA) as a comprehensive and developmentally appropriate assessment instrument for risk behaviors in Chinese adolescents.

Pathways to care: Narratives of American Indian adolescents entering substance abuse treatment

Using data from 89 American Indian adolescents and guided by the Network Episode Model, this paper analyses pathways to residential substance abuse treatment and their correlates. These adolescents were recruited at admission to a tribally-operated substance abuse treatment program in the southern United States from October 1998 to May 2001. Results from the qualitative analyses of these adolescent's pathways to care narratives indicated that 35% ultimately agreed with the decision for their entry into treatment; 41% were Compelled to enter treatment by others, usually by their parents, parole officers, and judges; and 24% did not describe a clear pathway to care. In the multinomial logistic regression model examining correlates of these pathways to care classifications, adolescents who described pathways indicative of agreement also reported greater readiness for treatment than the adolescents who described compelled or no clear pathways to care. Adolescents who described a Compelled pathway were less likely to meet diagnostic criteria for Conduct Disorder and described fewer social network ties. We were unable to find a relationship between pathways classifications and referral source, suggesting these narratives were subjective constructions of pathways to care rather than a factual representation of this process. In the final logistic regression model examining correlates of treatment completion, articulating a pathway to care, whether it was one of agreement or of being compelled into treatment, predicted a greater likelihood of completing treatment. Overall, these narratives and their correlates are highly consistent with the Network-Episode Model's emphasis on the interaction of self, situation, and social network in shaping the treatment seeking process, demonstrating the applicability of this model to understanding the treatment seeking process in this special population and suggests important considerations for understanding the dynamics of service utilization across diverse communities.

Migration from Mexico to the United States and conduct disorder: a cross-national study.

Twin studies suggest that conduct disorder (CD) is under substantial genetic influence, which is stronger for aggressive than for nonaggressive symptoms. Studies of migrating populations offer an alternative strategy for separating environmental and genetic influences on psychiatric disorders. To examine variation in the prevalence of CD associated with migration from Mexico to the United States and to determine whether this variation is similar for aggressive and nonaggressive CD symptoms and symptom profiles. The prevalences of CD, different types of CD symptoms, and CD symptom profiles were compared across 3 generations of people of Mexican origin with increasing levels of exposure to American culture: families of origin of migrants (residing in Mexico), children of Mexican migrants raised in the United States, and Mexican-American children of US-born parents. General population surveys conducted in Mexico and the United States using the same diagnostic interview. Adults aged 18 to 44 years in the household population of Mexico and the household population of people of Mexican descent in the United States. Conduct disorder criteria, assessed using the World Mental Health version of the Composite International Diagnostic Interview. Compared with the risk in families of origin of migrants, risk of CD was lower in the general population of Mexico (odds ratio [OR],0.54; 95% CI, 0.19-1.51), higher in children of Mexican-born immigrants who were raised in the United States (OR,4.12; 95% CI, 1.47-11.52), and higher still in Mexican-American children of US-born parents (OR,7.64; 95% CI, 3.20-18.27). The association with migration was markedly weaker for aggressive than for nonaggressive symptoms. The prevalence of CD increases dramatically across generations of the Mexican-origin population after migration to the United States. This increase is of larger magnitude for nonaggressive than for aggressive symptoms, consistent with the suggestion that nonaggressive symptoms are more strongly influenced by environmental factors than are aggressive symptoms.

Poly-substance use and antisocial personality traits at admission predict cumulative retention in a buprenorphine programme with mandatory work and high compliance profile

BackgroundContinuous abstinence and retention in treatment for alcohol and drug use disorders are central challenges for the treatment providers. The literature has failed to show consistent, strong predictors of retention. Predictors and treatment structure may differ across treatment modalities. In this study the structure was reinforced by the addition of supervised urine samples three times a week and mandatory daily work/structured education activities as a prerequisite of inclusion in the program.MethodsOf 128 patients consecutively admitted to buprenorphine maintenance treatment five patients dropped out within the first week. Of the remaining 123 demographic data and psychiatric assessment were used to predict involuntary discharge from treatment and corresponding cumulative abstinence probability. All subjects were administered the Structured Clinical Interview for DSM-IV-TR, and the Symptom Checklist 90 (SCL-90), the Alcohol Use Disorder Identification Test (AUDIT), the Swedish universities Scales of Personality (SSP) and the Sense of Coherence Scale (SOC), all self-report measures. Some measures were repeated every third month in addition to interviews.ResultsOf 123 patients admitted, 86 (70%) remained in treatment after six months and 61 (50%) remained in treatment after 12 months. Of those discharged involuntarily, 34/62 individuals were readmitted after a suspension period of three months. Younger age at intake, poly-substance abuse at intake (number of drugs in urine), and number of conduct disorder criteria on the SCID Screen were independently associated with an increased risk of involuntary discharge. There were no significant differences between dropouts and completers on SCL-90, SSP, SOC or AUDIT.ConclusionOf the patients admitted to the programme 50% stayed for the first 12 months with continuous abstinence and daily work. Poly-substance use before intake into treatment, high levels of conduct disorder on SCID screen and younger age at intake had a negative impact on retention and abstinence.

Patients' Contexts and Their Effects on Clinicians' Impressions of Conduct Disorder Symptoms

The purpose of this study was to examine whether contextual information about patients' clinical presentations affected clinicians' judgments of conduct disorder symptoms. Forty-five clinicians read vignettes describing hypothetical patients who displayed one conduct disorder symptom alongside information about the patients' home, school, and peer contexts. Clinicians judged the likelihood of patients meeting conduct disorder criteria. Contextual information highly affected judgments and these effects varied across the 15 conduct disorder symptoms. It is important to note that clinical judgments were not in agreement on the symptoms affected by context.

Directionality Between Tolerance of Deviance and Deviant Behavior is Age-Moderated in Chronically Stressed Youth

Problem behavior theory posits that tolerance of deviance is an antecedent to antisocial behavior and substance use. In contrast, cognitive dissonance theory implies that acceptability of a behavior may increase after experiencing the behavior. Using structural equation modeling, this investigation tested whether changes in tolerance of deviance precede changes in conduct disorder criteria or substance use or vice versa, or if they change concomitantly. Two-year longitudinal data from 246 8- to 16-year-olds suggested that tolerance of deviance increases after conduct disorder criteria or substance use in 8-to-10- and 11-to-12-year-olds. These results were consistent with cognitive dissonance theory. In 13-to-16-year-olds, no directionality was suggested, consistent with neither theory. These results were replicated in boys and girls and for different types of conduct disorder criteria aggression (covert behavior), deceitfulness and vandalism (overt behavior), and serious rule-breaking (authority conflict). The age-specific directionality between tolerance of deviance and conduct disorder criteria or substance use is consistent with unique etiologies between early onset versus adolescent-onset subtypes of behavior problems.

Conduct Disorder and the specifier callous and unemotional traits in the DSM-5

Preparations for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) are ongoing. Publication is planned in May 2013 and as part of the developmental process the preliminary draft revisions are now available for public review on the internet (http://www.dsm5.org). No revisions are being suggested for the main criteria of Conduct Disorder. However, an additional specifier for callous and unemotional (CU) traits in Conduct Disorder has been proposed. Both Conduct Disorder and the mentioned specifier are also on the list of proposed disorders to be studied in DSM-5 Fields Trials. On the DSM-5 site, the historical perspective, research basis, development and initial tests of criteria in secondary data analyses, and potential concerns about the proposed callous-unemotional specifier have been described by Frick and Moffitt [1]. Moreover, outside reviewers comments and suggestions for improvements are also published on the internet site. This paper will briefly summarize the background information described by Frick and Moffit and provides the comments on the proposed specifier in addition to those already made by outside reviewers.

Antisocial Personality Disorder With and Without Antecedent Childhood Conduct Disorder: Does It Make a Difference?

The purpose of this study was to test whether prior conduct disorder increased deviance in persons diagnosed with antisocial personality disorder. One hundred and three male inmates satisfying adult antisocial and conduct disorder criteria for antisocial personality disorder achieved significantly higher scores on self-report measures of criminal thinking and antisocial attitudes than 137 male inmates satisfying only the adult criteria for antisocial personality disorder and 87 male nonantisocial inmates. Inmates satisfying adult antisocial and conduct disorder criteria for antisocial personality disorder were also more likely to receive disciplinary infractions for misconduct than inmates in the other two conditions. The theoretical, diagnostic, and practical implications of these results are discussed.

The Illustration-Based Assessment of Liability and EXposure to Substance use and Antisocial behavior© for Children

Background/Objectives: Ontogenetic prevention of substance abuse requires that an individual's “profile” of substance abuse predictors is assessed to guide intervention decision-making (). For child intervention, self-report data provide information that cannot be obtained from other sources such as parents or teachers. However, efficient child report instruments of substance abuse risk factors are lacking. The Assessment of Liability and EXposure to Substance use and Antisocial behavior© (ALEXSA©) is an illustration-based, computerized child report assessment for early manifestations and predictors of substance abuse and antisocial behavior. Methods: Construct validity and test-retest reliabilities of ALEXSA subscales were estimated in 272 nine to twelve-year old students from regular and remedial education classrooms. Results: Anecdotal and quantitative data demonstrated that children enjoy the ALEXSA format. All factors and 34 of 39 subscales had good or better reliabilities. Nine factors were extracted: Disinhibition (example subscales are Irritability, Impulsivity), Sensation Seeking (e.g., Gambling, Social Disinhibition), Self Management (e.g., Planning and Concentration, Problem Solving), Family Discord (e.g., Family Behavior Problems, Family Conflict), Parent Fortification (e.g., Parental Monitoring, Parent Attachment), Social Contagion (e.g., Friends' Conduct Disorder Criteria, Peer Pressure Susceptibility), Social Support (e.g., Social Support: Adults, Number of Friends), Neighborhood Risks (e.g., Gang Exposure, Neighborhood Atmosphere), and School Protection (e.g., Academic Competency, School Commitment). Scientific Significance: The ALEXSA could provide efficient child reports for research, needs assessment, and outcomes to support etiology and prevention of substance abuse and antisocial behavior.

DSM-IV conduct disorder criteria as predictors of antisocial personality disorder

DSM-IV conduct disorder criteria as predictors of antisocial personality disorder