Disruptive Behavior Disorder Diagnosis Research Articles

Factors Associated with Confirmed and Unconfirmed Autism Spectrum Disorder Diagnosis in Children Volunteering for Research.

Diagnostic accuracy of autism spectrum disorder (ASD) is crucial to track and characterize ASD, as well as to guide appropriate interventions at the individual level. However, under-diagnosis, over-diagnosis, and misdiagnosis of ASD are still prevalent. We describe 232 children (MAge = 10.71 years; 19% female) with community-based diagnoses of ASD referred for research participation. Extensive assessment procedures were employed to confirm ASD diagnosis before study inclusion. The sample was subsequently divided into two groups with either confirmed ASD diagnoses (ASD+) or unconfirmed/inaccurate diagnoses (ASD-). Clinical characteristics differentiating the groups were further analyzed. 47% of children with community-based ASD diagnoses did not meet ASD criteria by expert consensus. ASD + and ASD- groups did not differ in age, gender, ethnicity, or racial make-up. The ASD + group was more likely to have a history of early language delays compared to the ASD- group; however, no group differences in current functional language use were reported by caregivers. The ASD + group scored significantly higher on ADI-R scores and on the ADOS-2 algorithm composite scores and calibrated severity scores (CSSs). The ASD- group attained higher estimated IQ scores and higher rates of psychiatric disorders, including anxiety disorder, disruptive behavior, and mood disorder diagnoses. Broadly, caregiver questionnaires (SRS-2, CCC-2) did not differentiate groups. Increased reported psychiatric disorders in the ASD- group suggests psychiatric complexity may contribute to community misdiagnosis and possible overdiagnosis of ASD. Clinician-mediated tools (ADI-R, ADOS-2) differentiated ASD + versus ASD- groups, whereas caregiver-reported questionnaires did not.

Adolescent smoking patterns: Associations with sociodemographic factors, cyberbullying, and psychiatric diagnoses in an outpatient clinical sample

There is a scarcity of research on smoking in adolescents within a clinical (outpatient) sample, and there is no existing knowledge on the relationship between cyberbullying and smoking in this population. The primary aim of this study is to determine the prevalence of smoking among adolescents in a clinical sample. Additionally, it aims to examine the potential associations between smoking status and factors such as socioeconomic characteristics, psychiatric diagnoses, and cyberbullying levels. A cross-sectional study was performed on 200 adolescents who visited a tertiary child and adolescent psychiatry outpatient clinic. Participants were assessed using the DSM-5 based psychiatric evaluation, the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version-DSM-5 Turkish Adaptation (K-SADS-PL-DSM-5-T), the Revised Cyber Bullying Inventory-II, and the Fagerström Test for Nicotine Dependence. The study found that 21% of the sample consisted of regular smokers, with a higher prevalence observed among older adolescents. The prevalence of depression and disruptive behavior disorders was significantly greater in the smoking group compared to other groups (p:0.043, p < 0.001, respectively). There was a significant difference in the scores for the cyberbullying bully subdimension among smokers (p = 0.013). The results of the multinomial logistic regression analysis indicated significant associations between smoking and age, maternal smoking status, friends smoking status, and a diagnosis of disruptive behavior disorder (p < 0.05 for all variables). This study reveals a significant prevalence of adolescent smoking in an outpatient clinic. These findings highlight the necessity of implementing focused smoking cessation interventions for this specific population.

Pediatric Off-label Antipsychotic Use for Attention-Deficit/Hyperactivity Disorder

PurposeOff-label antipsychotic use for behavioral symptoms in pediatric attention-deficit/hyperactivity disorder (ADHD) poses safety concerns, and evidence to support such use is limited. This study aims to investigate the risk of off-label antipsychotic use associated with comorbid disruptive behavior disorder (DBD) among a cohort of youth with ADHD. MethodsA cohort study was conducted using IQVIA PharMetrics Plus for Academics data from 2007 to 2020. Youth 5 to 15 years of age at the index ADHD visit were included in the cohort. The index ADHD visit meets at least 1 of the following criteria: (1) 1 inpatient ADHD visit, (2) 2 outpatient ADHD visits within 90 days, or (3) an ADHD medication prescription fill within 30 days of an outpatient ADHD visit. We excluded youth who had a diagnosis of DBD or a US Food and Drug Administration (FDA)–approved indication for antipsychotics at baseline. Youth were followed up until antipsychotic initiation or were censored at a loss of coverage, receipt of an FDA-indicated diagnosis, or end of the study. A Cox proportional hazards regression model with DBD as a time-varying covariate estimated the hazard of antipsychotic use after the index ADHD visit. FindingsOf 41,098 youth with ADHD who met the study criteria, 4557 were diagnosed with DBD during follow-up. The incidence of antipsychotic initiation was 19.6 (95% CI, 18.7– 20.5) per 1000 person-years. After adjustment for baseline covariates, the hazard ratio of antipsychotic initiation associated with DBD was 4.64 (95% CI, 4.15–5.18). ImplicationsAntipsychotic use among youth with ADHD is more likely in the presence of DBD, suggesting that an off-label use is for behavior problems.

Sex differences across developmental domains among children with a familial risk of severe mental disorders.

Sex differences in brain structure and neurodevelopment occur in non-clinical populations. We investigated whether sex had a similar effect on developmental domains amongst boys and girls with a familial risk of schizophrenia (FHR-SZ), bipolar disorder (FHR-BP), and controls. Through Danish registries, we identified 522 7-year-old children (242 girls) with FHR-SZ, FHR-BP, and controls. We assessed their performance within the domains of neurocognition, motor function, language, social cognition, social behavior, psychopathology, and home environment. FHR-SZ boys compared with FHR-SZ girls had a higher proportion of disruptive behavior and attention-deficit hyperactivity disorder (ADHD) and exhibited lower performance in manual dexterity, balance, and emotion recognition. No sex differences were found between boys and girls within FHR-BP group. Compared with controls, both FHR-SZ boys and FHR-SZ girls showed impaired processing speed and working memory, had lower levels of global functioning, and were more likely to live in an inadequate home environment. Compared with control boys, FHR-SZ boys showed impaired manual dexterity, social behavior, and social responsiveness, and had a higher proportion of ADHD and disruptive behavior disorder diagnoses. Stress and adjustment disorders were more common in FHR-BP boys compared with control boys. We found no differences between FHR-BP girls and control girls. Impairment within neurodevelopmental domains associated within FHR-SZ boys v. FHR-SZ girls was most evident among boys, whereas no sex differences were found within the FHR-BP group (FHR-BP boys v. FHR-BP girls). FHR-SZ boys exhibited the highest proportion of early developmental impairments.

A CASE STUDY ON COMPASSION FATIGUE AMONG TEACHERS HANDLING STUDENT WITH DISRUPTIVE BEHAVIOURS IN INCLUSIVE CLASSROOM

The case study highlights on examining the compassion fatigue among teachers handling student with disruptive behaviours in inclusive classroom. If a child has a diagnosis of disruptive behavior disorder, it may be decided to place him in a special classroom set up for more intensive behavior management. Compassion fatigue occurs when the person handling with the child with a disorder becomes so preoccupied with the disability of the child that it in turn makes the therapist or the helper stressful. Disruptive behavior disorders can seriously impact a child's daily life. Children with disruptive behavior disorders show ongoing patterns of uncooperative and deant behaviors. Treatment procedures involve therapy for such children to reduce the behavioral issues and provide positive reinforcement to improve self-control. The present study adopted a qualitative approach, a semi-structured interview was conducted among six teachers to assess the compassion fatigue while handling student with disruptive behavior in three different inclusive schools. The teachers were interviewed individually on two occasions to gather information on the impact of this phenomenon. The interview data were coded and categorized using thematic analysis. Through this analysis, three criteria were generated, that is, preparation and adaptation of learning materials, instructional process, and interpersonal relationships. The results revealed that the six teachers go through different emotional problems due to disruptive behaviours exhibited by their students and had health-related issues. It also showed that teachers' were mostly concerned with the loss of their instructional time. As a result of this, these teachers were unable to deliver the curriculum within the allocated time. The teachers' reported that the impact is not only the disruptively behaved child but the learning of the rest of the students were also hindered due to the disruptive behavioural issues. The implications of the ndings for teachers and further research are discussed

Multimodal Ensemble Deep Learning to Predict Disruptive Behavior Disorders in Children

Oppositional defiant disorder and conduct disorder, collectively referred to as disruptive behavior disorders (DBDs), are prevalent psychiatric disorders in children. Early diagnosis of DBDs is crucial because they can increase the risks of other mental health and substance use disorders without appropriate psychosocial interventions and treatment. However, diagnosing DBDs is challenging as they are often comorbid with other disorders, such as attention-deficit/hyperactivity disorder, anxiety, and depression. In this study, a multimodal ensemble three-dimensional convolutional neural network (3D CNN) deep learning model was used to classify children with DBDs and typically developing children. The study participants included 419 females and 681 males, aged 108–131 months who were enrolled in the Adolescent Brain Cognitive Development Study. Children were grouped based on the presence of DBDs (n = 550) and typically developing (n = 550); assessments were based on the scores from the Child Behavior Checklist and on the Schedule for Affective Disorders and Schizophrenia for School-age Children-Present and Lifetime version for DSM-5. The diffusion, structural, and resting-state functional magnetic resonance imaging (rs-fMRI) data were used as input data to the 3D CNN. The model achieved 72% accuracy in classifying children with DBDs with 70% sensitivity, 72% specificity, and an F1-score of 70. In addition, the discriminative power of the classifier was investigated by identifying the cortical and subcortical regions primarily involved in the prediction of DBDs using a gradient-weighted class activation mapping method. The classification results were compared with those obtained using the three neuroimaging modalities individually, and a connectome-based graph CNN and a multi-scale recurrent neural network using only the rs-fMRI data.

Parenting practices moderate the link between attention to the eyes and callous unemotional traits in children with Disruptive Behavior Disorder: An eye-tracking study

Callous-unemotional (CU) traits are associated with gaze pattern deficits in youths, though it has not yet been explored if environmental factors could influence this relationship. Since parenting can influence both CU traits and children's emotion processing, the current study sought to test whether parenting moderated the relation between gaze pattern deficits and CU traits in a sample of children with Disruptive Behavior Disorder. The sample included 92 boys (aged 7–12 years) with Conduct Disorder (N = 12) and Oppositional Defiant Disorder (N = 80). All children completed a task, during which they were presented with 24 images depicting happy, sad, fearful, disgusted, angry, and neutral facial expressions. Gaze pattern has been recorded throughout the task with an eye-tracker. Positive parenting moderated the association between CU traits and first fixation duration to the eyes of facial expressions depicting negative emotions. Negative parenting moderated the association between CU traits and fixation count and fixation duration to the eyes of negative emotions. Negative parenting along with reduced attention to emotional cues (i.e., eyes) may identify a group of youths with Disruptive Behavior Disorder diagnosis at risk for severe outcomes.

Agitation and Restraint in a Pediatric Psychiatric Emergency Program: Clinical Characteristics and Diagnostic Correlates.

Agitation and restraint among pediatric psychiatric patients are a frequent, yet little studied, source of morbidity and, rarely, mortality in the emergency department (ED). This study examined agitation and restraint among youth patients in a specialized pediatric psychiatric ED, considering clinical and sociodemographic characteristics of those who required restraint to determine the clinical correlates of agitation and restraint in this population. This descriptive study was a 6-year retrospective chart review of all patients restrained for acute agitation. Demographics, clinical characteristics, diagnoses, and reasons for restraint were collected. Relationships between sociodemographic and clinical variables to types of restraints used were examined, along with change over the study period in rate of and mean time in restraint. The average restraint rate was 1.94%, which remained fairly consistent throughout study period, although average time in restraint decreased significantly. Restraints were more common in males. Adolescents were overrepresented in the ED population, and after controlling for this, restraint rates were similar in adolescents and younger children. Physical aggression was the most frequent precipitant, although among adolescents verbal aggression was also a precipitant (more so than in younger children). Disruptive behavior disorder diagnoses were most frequently associated with restraint. A lower rate of restraint is reported here than has been seen in programs where youths are treated in medical or adult psychiatric EDs. Hospitals without specialized pediatric psychiatric emergency programs should invest in staff training in deescalation techniques and in access to pediatric psychiatric treatment. The finding that, of youth restrained, a significant proportion were under 12 years old and/or carried diagnoses not typically associated with aggressive behavior, indicates that crisis prevention, management, and treatment should include younger populations and diverse diagnostic groups, rather than focusing narrowly on older patients with psychotic or substance use disorders.

Attachment representations in children with disruptive behavior disorders: A special focus on insecurity in middle childhood.

According to the emotional and social problems encountered in disruptive behaviour disorder (DBD), there is little available information regarding the attachment processes during middle childhood. Therefore, this study aims to investigate the attachment representations to both caregivers in a sample of 84 children, aged 8-12 years (N = 42 with a diagnosis of DBD; N = 42 as a comparison group). Attachment is assessed through the Child Attachment Interview, a semi-structured interview that incorporates both narrative and behavioural assessments of attachment, permits the assessment of attachment representations using dimensional and categorical approaches, and allows for the detection of disorganisation to both parents individually. Our results point to the presence of high frequencies of insecure attachment (more than 80%) in the DBD group, with a higher percentage of dismissing attachment, and an over-representation of disorganised attachment (more than 50%). Higher levels of dismissal and lower levels of security are found in DBD than in the comparison group. No attachment differences with respect to both parents are found. Understanding how different aspects of attachment during a specific developmental phase plays a role within the broader emotional functioning of DBD has great potential to lead to innovations in evaluations and treatment processes.

Mental health disorders and adolescent peer relationships.

RationaleMental health disorders often arise during adolescence, with disruptive behavior disorders and anxiety disorders among the most common. Given the salience of peer relationships during adolescence, and research suggesting that mental health disorders negatively impact social functioning, this study uses novel methodology from social network analysis to uncover the social processes linking disruptive behavior disorders and anxiety disorders with adolescent friendships. In particular, the study focuses on peer withdrawal, peer popularity, and peer homophily in relation to both disorders.MethodsData come from 15-year old students in four Scottish secondary schools (N = 602). Diagnoses of disruptive behavior disorders and anxiety disorders were produced using the Diagnostic Interview Schedule for Children, and peer relationship data were obtained through a friendship nomination survey. Exponential random graph models were used to estimate the probability of peer withdrawal, peer popularity, and peer homophily based on each disorder.ResultsResults demonstrated that adolescents with disruptive behavior disorders were more popular than their peers without disruptive behavior disorders (OR: 1.47, CI: 1.20, 1.87). Friendship was also more likely between two adolescents both with or both without disruptive behavior disorders (OR: 1.26, CI: 1.07, 1.47), demonstrating peer homophily. There was no evidence that anxiety disorders were related to adolescent peer relationships.ConclusionsFindings from this study suggest that disruptive behavior disorders may be socially rewarded (e.g., peer popularity) and socially clustered (e.g., homophily), whereas anxiety disorders show no such trends. Thus, intervention efforts must account for the peer social status that may be gained from engaging in disruptive behavior during this developmental period. Further, given that similarity in DBD status is associated with an increased likelihood of friendship, adolescents are likely to be surrounded by peers who reinforce their behaviors.

Less imitation of arbitrary actions is a specific developmental precursor to callous-unemotional traits in early childhood.

Callous-unemotional (CU) traits in early childhood explain heterogeneity within conduct problems and are associated with higher risk for later diagnoses of childhood disruptive behavior disorders and antisocial behavior in adulthood. Emerging research implicates impairments in affiliative processes in the etiology of CU traits. The current study tests whether the imitation of intentional actions with no functional significance -a behavior that supports the acquisition of social conventions and affiliative bonds, is a specific developmental precursor to CU traits in early childhood. Data came from a longitudinal twin study of 628 children (Age 2: 47% females; Age 3: 44.9% females) with observations of arbitrary (i.e., nonfunctional actions) and instrumental (i.e., functional actions) imitation and parent reports of CU traits and oppositional defiant (ODD) behaviors at ages 2 and 3. Lower arbitrary imitation at age 2, but not instrumental imitation, was related to increases in CU traits from ages 2 to 3 (β=-.10, p=.02). These findings establish early social and affiliative processes in the etiology of CU traits, highlighting that novel personalized treatment and intervention strategies for CU traits may benefit from targeting these processes to help reduce CU traits and risk for persistent conduct problems in children.

Personality heterogeneity in adolescents with disruptive behavior disorders

We first confirmed adolescents diagnosed with disruptive behavior disorders (oppositional defiant, conduct disorder; n = 158) had lower constraint and higher negative emotionality, and greater psychiatric comorbidity and psychosocial dysfunction, relative to adolescents without (n = 755), in a population-based sample enriched for externalizing psychopathology (mean age = 17.90 years; 52% female). We then explored whether different personality types, defined by patterns of personality identified via latent profile analysis, were differently associated with clinical features in adolescents with a disruptive behavior disorder diagnosis. Four distinct personality types (“disinhibited,” “high distress,” “low distress,” “positive”) were meaningfully different from one another. Results highlight personality heterogeneity as a means of identifying individuals at greatest risk for the most deleterious forms of externalizing psychopathology.

Emotional processing deficits in Italian children with Disruptive Behavior Disorder: The role of callous unemotional traits

Research suggests that callous unemotional (CU) traits are associated with poor emotion recognition due to impairments in attention to relevant emotional cues. To further investigate the mechanisms that underlie CU traits, this study focused on the relationship between levels of CU and children's attention to, and recognition of, facial emotions. Participants were 7- to 10-year-old Italian boys, 35 with a diagnosis of Disruptive Behavior Disorder (age: M = 8.93, SD = 1.35), and 23 healthy male controls (age: M = 8.86, SD = 1.35). Children viewed standardized emotional faces (happiness, sadness, fear, disgust, anger, and neutral) while eye-tracking technology was used to evaluate scan paths for each area of interest (eyes, face, mouth), and for each emotion. CU traits were assessed using parent and teacher ratings on the Antisocial Process Screening Device. In the whole sample, elevated levels of CU traits were associated with a lower ability to recognize sadness, a lower number of fixations, and a lower average length of each fixation, specifically to the eye area of sad faces. In children with Disruptive Behavior Disorder diagnoses, high levels of CU traits were associated with lower duration of fixations to the eye-region on the eye area of sad faces, which in turns predicted lower levels of sadness recognition. The findings confirm that poor emotion recognition is associated with impairments in attention to critical information about other people's emotions. The clinical implications are discussed.

Diagnosis, risk factors, evolutionary trajectories and treatment of disruptive behavior disorders: Coping Power Program’s diffusion in Italy

Knowing and diagnosing carefully a Disruptive Behavior Disorder, analyzing the clinic consistency of the subtypes DC and CU as well as the etiological, neurocognitive and neurobiological specificities, will allow the clinician to perform a much more precocious diagnosis. The comprension of the factors that are associated with aggressiveness and disruptive behaviors contributed to the development of interventions in order to prevent and reduce the impact of these disorders, which can evolve into juvenile delinquency or antisocial personality disorders, if not treated. This article, after an exposition of the new DBD criteria in the DSM V and an analysis of the risk factors for aggressive children, will outline the researches on this topic, and will describe the intervention protocol named Coping Power Program (CPP), as well as listing some researches, including the italian ones, that confirmed the effectiveness of this protocol.

Disruptive behavior disorders among basic-learning school children at Qwiesna district, Menoufia Governorate, Egypt (2014/2015)

Disruptive Behavior Disorders (DBDs) are psychiatric disorders of children and adolescence including Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD). DBDs are associated with increased risk for negative developmental outcomes including substance abuse, school problems and antisocial or criminal violence. Objective of the study was to assess Disruptive Behavior Disorders among basic learning school children in Qwiesna district , Menoufia governorate. A cross-sectional study was conducted on 348 basic learning school children and their parents in addition to their Classrooms' teachers'. Children were subjected to Mini-Kids Interview for diagnosis of DBDs then ''Parenting Manner Scale'' for detection of parenting style. Parents and teachers rated child's behavior at their home and school respectively during past six months. Parents were subjected to ''socioeconomic status scale. The results of the study showed that, Prevalence of DBDs was 14.9%. ODD and CD were 8% and 6.9 % of cases respectively. Mean age was significantly younger among patients (11.69±1.6) with male sex predominance (69.2%). Low Socioeconomic level (67.3%), inter-parental conflicts (36.5%), single parent (51.9%) and family history of neuropsychiatric disorders (65.4%) were significantly higher among cases. Overprotection (28.8% and 28.8%), discrimination between siblings (28.8% and 28.8%) and authoritarian fathers and mothers parenting styles (17.3% &amp; 19.2%) respectively were significantly higher among cases. The study concluded that, Prevalence of DBDs among basic learning school children in Qwiesna district, Menoufia governorate was 14.9%.ODD and CD represented 8% and 6.9% of cases respectively. Risk factors were; low socioeconomic status (OR 3.4), low parental educations (OR 1.07 &amp;2.9 for fathers and mothers respectively), father smoking (OR 1.4), parental conflicts (OR 1.3), family history of psychiatric disorders (OR 1.6) and bad parental styles among fathers and mothers respectively [overprotection (OR 49.4 &amp; 22.2), discrimination (OR 12.9 &amp; 32.8), authoritarian (OR 11.2 &amp; 20.9) and hesitancy (OR 8.8 &amp; 28.7)].

Specificity of Reward Sensitivity and Parasympathetic-Based Regulation among Children with Attention-Deficit/Hyperactivity and Disruptive Behavior Disorders.

Attention-deficit/hyperactivity disorder (ADHD) is associated with disruptionsin reward sensitivity and regulatory processes. However, it is unclear whether thesedisruptions are better explained by comorbid disruptive behavior disorder (DBD)symptomology. This study sought to examine this question using multiple levels ofanalysis (i.e., behavior, autonomic reactivity). One hundred seventeen children (aged 6 to 12 years; 72.6% male; 69 with ADHD) completed theBalloon-Analogue Risk Task (BART) to assess external reward sensitivity behaviorally.Sympathetic-based internal reward sensitivity and parasympathetic-based regulationwere indexed via cardiac pre-ejection period (PEP) and respiratory sinus arrhythmia(RSA), respectively. Children with ADHD exhibited reduced internal reward sensitivity (i.e.,lengthened PEP; F(1,112)=4.01, p=0.047) compared to healthy controls and werecharacterized by greater parasympathetic-based dysregulation (i.e., reduced RSAaugmentation F(1,112)=10.12, p=0.002). However, follow-up analyses indicated theADHD effect was better accounted for by comorbid DBD diagnoses; that is, childrenwith ADHD and comorbid ODD were characterized by reduced internal rewardsensitivity (i.e., lengthened PEP; t=2.47, p=0.046) and by parasympathetic-baseddysregulation (i.e., reduced RSA augmentation; t=3.51, p=0.002) in response to rewardwhen compared to typically developing youth. Furthermore, children with ADHD and comorbid CD exhibited greater behaviorally-based external reward sensitivity (i.e.,more total pops; F(3,110)= 5.96, p=0.001) compared to children with ADHD only (t=3.87, p=0.001) and children with ADHD and ODD (t=3.56, p=0.003). Results suggest that disruptions in sensitivity to reward may be betteraccounted for, in part, by comorbid DBD.Key Words: attention-deficit/hyperactivity disorder, autonomic nervous system,disruptive behavior disorders, reward sensitivityPowered.

A Pilot Study Implementing Coping Power in Italian Community Hospitals: Effect of Therapist Attachment Style on Outcomes in Children

The study presented the initial report of a project regarding the implementation of the Coping Power Program in Italian community hospitals, and the program’s ability to reduce externalizing behavioral problems in children with a Disruptive Behavior Disorder diagnosis. Usually, interventions for children are implemented by a number of therapists with different personal characteristics, which therefore influence the implementation quality of an intervention. That said, the present study aimed to establish whether the insecure attachment styles of therapists predict unfavorable outcomes for children treated with the Coping Power Program. The sample included 80 children with a Disruptive Behavior Disorder diagnosis and 16 therapists. The results showed that the change in children’s aggressive behavioral problems was significantly related to the levels of the therapist’s preoccupation with relationships. Higher levels of change in aggression (where a higher value means that the aggression at the end of the treatment is higher than aggression at the baseline evaluation) are associated with higher levels of therapist’s preoccupied attachment style (anxious attachment style). This study provided some preliminary evidence that therapists need to be sensitive to their own attachment experiences when delivering therapy for children.

Disruptive behavior disorders among basic-learning schoolchildren at Quweisna District, Menoufia Governorate, Egypt (2014/2015)

Background Disruptive behavior disorders (DBDs) are psychiatric disorders of children and adolescents, including oppositional defiant disorder (ODD) and conduct disorder (CD). It is associated with an increased risk for negative developmental outcomes including substance abuse, school problems, and antisocial or criminal violence. Objective The objective of this study was to assess the prevalence of DBDs among basic-learning schoolchildren in Quweisna District, Menoufia Governorate, its types, and its risk factors. Participants and methods A cross-sectional study was conducted on 348 basic-learning schoolchildren and their parents, as well as their teachers. Children were subjected to mini-kids interview for diagnosis of DBDs and then 'Parenting Manner Scale' for the detection of parenting style. Parents and teachers rated the child's behavior at home and school, respectively, during the past 6 months. Parents were subjected to the socioeconomic status scale. Results Prevalence of DBDs was 14.9%. The prevalence of ODD and CD was 8 and 6.9%, respectively. Mean age was significantly lower among patients (11.69 ± 1.6), with male sex predominance (69.2%). Low socioeconomic level (67.3%), interparental conflicts (36.5%), single parent (51.9%), and family history of neuropsychiatric disorders (65.4%) were significantly higher among cases. Overprotection (28.8 and 28.8%), discrimination between siblings (28.8 and 28.8%), and authoritarian parenting styles (17.3 and 19.2%), were significantly more prevalent among cases. Conclusion Prevalence of DBDs among basic-learning schoolchildren in Quweisna District, Menoufia Governorate, Egypt, was 14.9%. Its types were ODD and CD represented by 8 and 6.9%, respectively. Risk factors for DBDs among the studied group were low socioeconomic status, low parental education, father smoking, parental conflicts, family history of neuropsychiatric disorders, and bad parental styles among fathers and mothers (overprotection, discrimination, authoritarian, and hesitancy).

Development of Alcohol and Drug Use in Youth With Manic Symptoms

This analysis examined alcohol and drug use over a 6-year follow-up of children in the Longitudinal Assessment of Manic Symptoms (LAMS) study. LAMS screened 6- to 12.9-year-old children visiting 9 child outpatient mental health (MH) clinics, using the Parent General Behavior Inventory 10-item mania scale. All children with scores≥12 and a matched group with scores≤12 were invited to enroll. Children were assessed every 6 months. Assessments included demographics, family, MH history, child diagnoses, child stress, and alcohol and drug use. Univariate, bivariate, and interval censored survival analyses were conducted. Of those >9 years at baseline, 34.9% used alcohol at least once, with 11.9% regular users; 30.1% used drugs at least once, with 16.2% regular users. Predictors of any alcohol use were parental marital status, older age at study entry, a primary diagnosis of disruptive behavior disorders at baseline, and number of impactful child life events. Predictors of regular alcohol use included parental marital status, age, and sustained high mania symptoms over the first 24 months of follow-up. Predictors of any drug use were single parent, parental substance use, and stressful child life events. Predictors of regular drug use were parental marital status, stressful child life events, and a baseline disruptive behavior disorder diagnosis. Baseline medications decreased the risk of regular drug use. Longitudinal data on youth with elevated manic symptoms suggest that comorbid disruptive behavior disorder, manic symptom burden, family environment, and stress are predictors of initiation and regular use of substances.

Do post-trauma symptoms mediate the relation between neurobiological stress parameters and conduct problems in girls?

ObjectiveAttenuated activity of stress-regulating systems has consistently been reported in boys with conduct problems. Results in studies of girls are inconsistent, which may result from the high prevalence of comorbid post-trauma symptoms. Therefore, the aim of the present study is to investigate post-trauma symptoms as a potential mediator in the relation between stress-regulation systems functioning and conduct problems in female adolescents.MethodsThe sample consisted of 78 female adolescents (mean age 15.4; SD 1.1) admitted to a closed treatment institution. The diagnosis of disruptive behaviour disorder (DBD) was assessed by a structured interview—the diagnostic interview schedule for children version IV (DISC-IV). To assess post-trauma symptoms and externalizing behaviour problems, self-report questionnaires, youth self report (YSR) and the trauma symptom checklist for Children (TSCC) were used. The cortisol awakenings response (CAR) measured hypothalamic–pituitary–adrenal (HPA) axis activity, whereas autonomous nervous system (ANS) activity was assessed by heart rate (HR), pre-ejection period (PEP) and respiratory sinus arrhythmia (RSA). Independent t-tests were used to compare girls with and without DBD, while path analyses tested for the mediating role of post- trauma symptoms in the relation between stress regulating systems and externalizing behaviour.ResultsFemales with DBD (n = 37) reported significantly higher rates of post-trauma symptoms and externalizing behaviour problems than girls without DBD (n = 39). Path analysis found no relation between CAR and externalizing behaviour problems. With regard to ANS activity, positive direct effects on externalizing behaviour problems were present for HR (standardized β = 0.306, p = 0.020) and PEP (standardized β = −0.323, p = 0.031), though not for RSA. Furthermore, no relation—whether direct or indirect—could be determined from post-trauma symptoms.ConclusionsPresent findings demonstrate that the neurobiological characteristics of female externalizing behaviour differ from males, since girls showed heightened instead of attenuated ANS activity. While the prevalence of post-trauma symptoms was high in girls with DBD, it did not mediate the relation between stress parameters and externalizing behaviour. Clinical implications and future directions are discussed.