Millon Adolescent Clinical Inventory Research Articles

Comparative analysis of characteristics among young people discharged from adolescent medium secure psychiatric hospital

BackgroundSpecialised forensic mental health provision for young people with mental disorders and high-risk behaviours has developed significantly in the UK. Despite this, research on the young people within secure settings remains limited. Adolescents in secure settings exhibit higher levels of mental disorders and have complex needs. This study aims to compare the demographic characteristics of patients discharged from an adolescent medium secure unit (AMSU) to different discharge destinations: community, another hospital, or custodial setting. MethodsA retrospective study was conducted using data from 155 patients admitted to a UK AMSU from 2008 to 2021. Demographic data, clinical information and Millon Adolescent Clinical Inventory (MACI) scores were extracted from electronic health records. A descriptive statistical method was used to report observational differences in patient characteristics between discharge locations. Statistical analysis included Chi-squared tests and AVOVA testing. ResultsPatients discharged to different settings exhibited distinct demographic and clinical characteristics. Those discharged to custodial settings were predominantly male and often transferred from custodial settings. Those discharged to other hospitals were mostly females with a diagnosis of Borderline Personality Disorder. The community-discharged group had a higher frequency of admissions from other hospitals under civil sections. Multiple variables were found to be statistically significant in relation to discharge location including gender and age at discharge. Findings of the MACI were not statistically significant in relationship with discharge location. ConclusionsThe study enhances understanding of healthcare transitions from AMSUs. The influence of diagnoses, particularly personality disorders, and their connection to admission duration is explored, as is the influence of this on transitioning patients across care settings. The impact of trauma-informed, attachment focussed models of care in regards transitions from AMSUs is also examined. Despite diversity in discharge locations, self-reported personality questionnaires show consistent outcomes, demonstrating psychological similarities across groups. Further research is needed to understand post-discharge trajectories enabling targeted interventions and improved care pathways.

B - 88 The Role of Cognitive Functioning on Trauma and Suicidality in Inpatient Cisgender and Gender-Minority Youth.

This study aimed to examine how executive functioning (EF) and processing speed (PS) moderate the relationship between adverse childhood experiences (ACE's) and suicidality in cisgender and gender-minority youth (GMY) in an inpatient setting. We hypothesized that neurocognitive domains will moderate the relationship between ACE's and suicidality in GMY. An inpatient psychiatric sample of 43 GMY and 43 cisgender adolescents ages 13-19 (M = 15.02, SD = 1.57) participated in this study. Participants completed the ACEs to measure cumulative trauma exposure, and the Millon Adolescent Clinical Inventory that assessed suicidality. EF and PS composite scores were used as moderators. Two regression models were conducted to examine how EF, PS, ACEs, and the ACEs*EF and ACEs*PS interactions predicted suicidality for cisgender and GMY respectively. For cisgender adolescents, no significance was found in the regression model (F(5,36) = 1.11, p = 0.370) or interactions between ACEs and EF (b = -2.24, p = 0.122) or PS (b = 2.14, p = 0.390). Although the regression model was not significant (F(5,37) = 1.52, p = 0.207) for GMY, there were significant crossover interactions between ACEs and EF (b = -3.50, p = 0.013; 95%CI = -6.20, -0.80), and PS (b = -3.67, p = 0.027; 95%CI = 0.44, 6.90) on suicidality. These results suggest that EF and PS meaningfully attenuate the relationship between ACEs and suicidality for GMY in an inpatient setting whereas this attenuation is not seen in their cisgender counterparts. Such findings can lead to better indicators and interventions for GMY in inpatient settings.

Adolescents with harmful sexual behaviours in New Zealand: could assessment of personality-based classifications help guide therapeutic interventions?

The purpose of the present study was to report on a pilot study using a personality-based classification of a community-based sample of 298 adolescent males with harmful sexual behaviours (AHSB) using the Millon Adolescent Clinical Inventory (MACI). Three personality-based profile types were identified using cluster analysis: Cluster 1. Detached, a detached and socially isolated type (n = 97); Cluster 2. Offending Supportive, an antisocial, offending-supportive type (n = 73); and Cluster 3. Typical Teen/Restricted, a type with few clinically elevated personality characteristics (n = 128). Further analyses indicated significant differences among the personality-based profiles on the MACI subscales that measured response styles, adolescents’ concerns and clinical problems. Few statistically significant relationships between the profile types and AHSB, offence and victim characteristics were found. The clinical implications of these findings are discussed, and the need for further research on the use of personality-based classification is recommended.

Personality in adolescents of general and clinical samples

The main objective of the study was to analyze the differences between samples from general and clinical sample in personality prototypes (PRP), derived from the Millon Adolescent Clinical Inventory (MACI). The methodology included an analytical and observational design with a random, multi-stage, stratified and proportional cluster sampling in general sample (n= 461) and consecutive sampling of clinical sample (n= 219), in adolescents between 13 and 17 years of age. We found introvert, inhibited, doleful, forceful, oppositional, self-demeaning and borderline PRP in the clinical sample and dramatizing and conforming PRP in the general sample present a significantly higher mean. There is a relevant absence of significant differences in egotistic, submissive, and unruly PRP. By sex, more significant differences in PRP are observed in the clinical sample. By age, a significant downward linear trend in the submissive and conforming PRP is observed, as well as an upward trend in the unruly and forceful PRP in the general sample. The clinician must be alert in the interpretation of the MACI PRP that do not differentiate between general and clinical samples.

Gender differences in adolescents with suicidal behaviour: Personality and psychopathology

This study evaluates the relationship between gender, personality, psychopathology and suicidal behaviour among adolescents. For this purpose, across-sectional study with adolescent inpatients (N = 92) displaying suicidal behaviour was designed. Sociodemographic characteristics and data related to suicidal behaviour were collected. In addition, personality and clinical severity were assessed by administering the Millon Adolescent Clinical Inventory (MACI). Results revealed that the most prevalent personality dimensions for both genders were Introversive, Self-demeaning, Doleful, Oppositional, Borderline tendency and Inhibited. However, men scored higher in Inhibited (p = 0.02, Cohen’s d = 0.45) and women in Egotistic(p = 0.03, Cohen’s d = 0.40). Concerning clinical severity of syndromes, women scored higher in Delinquent Predisposition (p = 0.04, Cohen’s d = 0.45) and men in Anxious Feelings (p = 0.02, Cohen’s d = 0.51), Depressive Affect (p = 0.04, Cohen’s d = 0.41) and Suicidal Tendency (p = 0.03, Cohen’s d = 0.37), with men reporting more frequently Childhood Abuse (p < 0.001, Cohen’s d= 0.70). Results highlight the importance of universal interventions to promote a change in attitudes towards seeking psychological help, specially in men, and the need to design effective tailored treatments to acquire emotional management skills for both genders

Child Abuse scale elevations on the MACI as related to abuse type

ABSTRACT Child maltreatment often results in the involvement of Child Protection Services and need for psychological evaluation to assist with diagnosis and treatment. As such, evaluators must understand population specific response patterns and their impact upon test interpretation. The current study aimed to evaluate whether adolescents who experienced maltreatment would significantly elevate the Child Abuse scale on the Millon Adolescent Clinical Inventory (MACI; Millon, 1993) and if elevations occurred across all abuse types or were limited to abuse with a physical impact. The study used 194 youth, 13 to 18 years old, who were referred for evaluation at a regional diagnostic and treatment center for child maltreatment, and experienced maltreatment as deemed by a clinician. The MACIs were scored utilizing Pearson’s Q-local and Q-Global services. Frequency analysis and t-tests were performed. The majority of youth (n= 135) did not have clinically significant scores on the Child Abuse scale. Youth who experienced physical (n= 158) versus non-contact (n= 36) forms of abuse had higher scores on the Child Abuse scale (M= 59.97 and M= 35.39 respectively; p< .001). The results demonstrate how the MACI contributes information to evaluations of childhood maltreatment, while highlighting the impact of abuse type on scale elevations.

Psychiatric and personality factors in pediatric functional seizures: A prospective case-control study

PurposeThis study assessed psychiatric and personality characteristics in relation to pediatric functional seizures (FS). MethodsIn a 1:1 prospectively matched-control study design, children with documented FS (confirmed via video EEG; ages 13–18) were matched to controls (MCs) on income, sex, race, and age. Primary outcomes were Behavior Assessment System for Children, Second Edition (BASC-2) and Millon Adolescent Clinical Inventory (MACI). Secondary measures included questionnaires assessing trauma, somatization, body awareness and quality of life (QOL). T-tests investigated differences between groups on T-scores. Due to lack of significant outcomes, an experimental analysis was conducted assessing differences in number of clinically elevated BASC-2 and MACI scores between groups. Binary logistic regressions determined the influences of clinically elevated scores on likelihood participants have FS. T-tests assessed differences on secondary measures. ResultsParticipants included 84 children, 42 with FS and 42 MCs (Children with FS: Meanage=15.4, Interquartile Rangeage=3; 73.5% female; 59.5% white). Children with FS had greater parent-reported somatization (t(23)=5.67, p<0.001) on BASC-2, greater somatization on CSSI-24 (t(35)=6.83, p<0.001), and poorer QOL (t(41)=-6.22; p<0.001) than MCs. There were no differences in clinically elevated BASC-2 or MACI scores compared to MCs and clinically elevated scores did not influence likelihood participants have FS. ConclusionsChildren with FS had greater somatization and poorer QOL but similar rates of psychiatric symptoms, trauma, and maladaptive personality traits compared to MCs. Psychiatric or personality factors did not predict likelihood of FS. Explanations of pediatric FS should consider novel contributors to FS rather than relying solely on a psychiatric etiology.

Intersection between Justice-Involved Youth Personality Profiles and Criminal Risk-Need Patterns

To purpose of the current study was to inform system level decision-making about the value of integrating clinically relevant personality information with criminogenic need risk appraisal in justice-involved youth. Using a Canadian sample of youth referred for court-ordered psychological assessments (N = 201, M age=15.62 years; 70% male), we examined the patterns of association and differentiation between youths’ Youth Level of Service/Case Management Inventory (YLS/CMI) criminogenic need/risk profiles with personality profiles derived from the personality scales of the Millon Adolescent Clinical Inventory (MACI, Millon, Millon adolescent clinical inventory. National Computer Systems, 1993). Specifically, latent profile analysis identified four MACI based personality profiles: externalizing, internalizing, dependent/followers, and complex dysregulated personality profiles. These groups varied significantly on YLS/CMI risk-need profiles. Although both externalizing and complex dysregulated sub-types represented higher criminal risk, their intervention needs diverged meaningfully. These results provide insight into the heterogeneity of justice-involved youth and point to the need for system resources that allow for appropriate intervention matching to maximize the goal of recidivism risk reduction in youth.

Fatigue and conformist traits in the performance of young swimmers

Objective: This study determines the relationship between the fatigue of adolescent swimmers in high-level competitions during two continuous periods of maximum performance and the degree that swimmers conform to norms during these periods.&#x0D; Methods: We evaluated the conformist trait and three areas of fatigue in two consecutive competitive periods, in 25 young elite swimmers. The measures were evaluated before (_B) and after (_A) of pre (t1; t3) and pos (t2; t4) competition in each period. Millon Adolescent Clinical Inventory was applied for identifies the more adherens (AD; n=12) or detached from the norm (DN; n=13) conformist traits. Wingate test, Heart rate variability (RMSSD; SDNN), WISC-V, and Stroop test were evaluated.&#x0D; Results: DN group present lower fatigue in t1 but an increase in t2, t3, and t4. AN present higher RMSSD_B and SDNN_B in t1. In t3, the mental fatigue of DN was correlated negatively with RMSSD_B; SDNN_B. Both groups had more SDNN_B than SDNN_A in t4.&#x0D; Conclusions: Physical fatigue was important conditioning in both groups, however, the DN group may be more sensitive to physiological and mental fatigue directly affecting the performance.

Mental Health of Adolescents in the Era of Antiretroviral Therapy: Is There a Difference Between HIV-Infected and Uninfected Youth in South Africa?

PurposeThe HIV infection may predispose perinatally HIV-infected (PHIV+) adolescents to mental illness. Adolescence can be when mental health disorders manifest for the first time. This study investigates the prevalence of mental illness in PHIV+ and HIV-uninfected adolescents in Soweto. MethodsPHIV+ adolescents aged 13–19 years were recruited from an antiretroviral treatment program, whereas HIV-uninfected controls were recruited from the community in Soweto, South Africa, between October 2016 and April 2017. The Patient Health Questionnaire for Adolescents, Child Post-Traumatic Stress Disorder (PTSD) Checklist, and Millon Adolescent Clinical Inventory tools assessed components of mental health. Sociodemographic and virological data were collected. Risk factors for suicidality were determined by logistic regression. ResultsOne hundred and sixty-two adolescents (50% PHIV+, 61% female) with a median age of 16 years (interquartile range: 15–18) were enrolled. A depressive disorder was found in 14% of all adolescents, 35% had suicidal ideation, and 22% had PTSD symptoms. Risk factors for suicidality were female gender, HIV-positive status, repeating a grade at school and a history of physical and/or sexual abuse. ConclusionsThese findings show a high prevalence of suicidality and PTSD symptoms in adolescents from South Africa and highlight the importance of screening for mental illness, specifically suicidality, in HIV-positive adolescents. Adolescents from a disadvantaged socioeconomic background appear to be at risk, posing a challenge because of the lack of health seeking behaviors in young people and lack of adolescent-friendly health facilities. Interventions specific to adolescents in low- and middle-income countries are needed to improve emotional and psychiatric symptoms and functioning.

Characteristics and personality profiles of first 100 patients admitted to a secure forensic adolescent hospital

ABSTRACTBluebird House is a mixed-gender adolescent medium-secure forensic unit. There is a paucity of data available about this unique patient group. We aimed to explore the demographic, clinical and personality characteristics of the first 100 patients admitted to a mixed-gender adolescent medium-secure forensic unit. We used a retrospective cross-sectional study of the first 100 consecutive patients admitted to Bluebird House. Demographic and clinical data were collected from the medical notes including the Millon Adolescent Clinical Inventory. The first 100 young people admitted to an adolescent medium-secure unit have had very high incident rates, particularly amongst the females. Incident rate was correlated with a history of sexual assault in female patients. The males were more likely to have been referred from custody and more likely to have a diagnosis of psychosis or autism. We describe similarities and differences to the first 100 admissions admitted to the first secure psychiatric unit for adolescents in Manchester over 20 years ago.

Comparative study of adolescents with and without ADHD

Introduction. Although an association between attention deficit hyperactivity disorder (ADHD) and personality disorders has been observed in adult population, no descriptions in Chilean adolescents have been reported. Objective. To explore personality profiles in Chilean adolescent patients diagnosed with ADHD. Method. Non-experimental, comparative design, convenience sample with 61 adolescent patients (13-19 years old) diagnosed with ADHD who completed the Millon Adolescent Clinical Inventory (MACI) questionnaire. Results compared parameters for the Chilean adolescent population and patients in the study. Attending psychiatrists completed a medical history file (comorbidities, pharmacological treatment and factors associated with mental health). Multivariate statistics, cluster analyses, and means comparison analyses were performed. This project was approved by the Ethics Committee of the University of Chile. Results. The personality profile of female adolescent patients with ADHD resembles that of the general female population, while the profile of the male patients is similar to that of the patient’s parameter group. Cluster analysis identified two personality sub-profiles: 25% of the subjects belonged to cluster 1, which was characterized by higher scores for different personality traits, expressed concerns, and clinical syndromes, compared with subjects from cluster 2. There were no differences regarding gender, ADHD clinical presentation, use of medication, adverse childhood experiences (ACEs), type of school, grade retention, or, applicable only to the female group, comorbidities in belonging to cluster 1. Only the presence of comorbidity in male subjects was associated with cluster 1 membership. Discussion and conclusion. Adolescent patients diagnosed with ADHD differed significantly in some personality traits when compared to Chilean parameters for the MACI. Of the adolescents studied, 25% have maladaptive personality characteristics.

The influence of the aesthetic body shape model on adolescents with eating disorders.

the relevance of sociocultural factors with respect to etiology, development and treatment of eating disorders has been supportedby many studies. the aims of this study were: a) to analyze the different effects of the aesthetic body shape model on adolescents with anorexia nervosa(AN) vs bulimia nervosa (BN); b) to analyze possible differences, regarding that body shape model, between patients with purging behaviors vsnon purging types of patients; and c) to explore the relationship between the influence of the aesthetic body shape model and other clinicallyrelevant variables such as body dissatisfaction, eating attitudes and personality traits. the sample comprised 104 adolescents suffering from AN and BN. The Questionnaire of Influences on the Aesthetic Body ShapeModel (CIMEC-40), the Body Shape Questionnaire (BSQ), the Eating Attitudes Test (EAT-40) and the Millon Adolescent Clinical Inventory (MACI)were applied. the aesthetic body shape model of thinness influenced 77.9% of this sample, this influence being higher in the case of BN patients.In addition, that influence was stronger in the purging-type patients than in the non-purging type. Moreover, there was a significant and positivecorrelation among the influence of the aesthetic body shape model, body dissatisfaction and severity of eating symptoms. Finally, there seemsto exist some personality traits more vulnerable to be affected by sociocultural factors. in view of these results, it is necessary that psychotherapeutic approaches take into account the influence of sociocultural factorsand body dissatisfaction mainly in the case of adolescents with BN.

Heterogeneity in Male Adolescents With Illegal Sexual Behavior: A Latent Profile Approach to Classification.

Current research has established that male adolescents with illegal sexual behavior (AISB) are a heterogeneous population. We aimed to explore this within-group heterogeneity to derive clinically relevant groups of AISB using the Millon Adolescent Clinical Inventory (MACI). We then compared these groups on selected covariates (age at intake, minority status, and child maltreatment history) and distal outcomes (general, nonviolent, violent, drug, and sexual recidivism 5 years after release) to identify any differences. The sample consisted of 698 male AISB (age = 11-20 years) referred to a secure juvenile facility for assessment and treatment. A latent profile analysis (LPA) was conducted using the clinical and personality scales of the MACI to identify AISB groups and examine group differences. Four unique AISB groups emerged: Anxious, Depressed/Anxious, Dysthymic/Disorganized, and Antisocial. Groups differed on age at intake and child maltreatment history, but not minority status. At 5-year follow up, groups differed in their rates of general, nonsexual, and violent recidivism but not in their rates of sexual or drug recidivism. Clinically relevant AISB groups can be identified using personality and psychopathology indicators from the MACI. Implications for the assessment and treatment of AISB, as well as directions for future research are discussed.

Spanish version validation of the Marihuana Motives Measure in a drug-consuming adolescent sample.

Cannabis is the illicit drug mostly widely consumed by adolescents in Spain. The understanding of consumption motives is an important factor for intervention. In Spain, there are no available instruments for their evaluation, hence, the goal of this paper is to study the psychometric properties of the Marihuana Motives Measure (MMM) in a sample of adolescent consumers. Firstly, translation and back-translation was performed. A total of 228 adolescent consumers of cannabis were evaluated. Factorial analysis was conducted, and the reliability of the total scores and of each scale of the questionnaire was studied through Cronbach's alpha. Test-retest reliability was analyzed through interclass correlations. Validity evidence of the MMM was examined through correlations between current cannabis use, subjective consumption effects measured with the Addiction Research Center Inventory (ARCI), and personality measured with the Millon Adolescent Clinical Inventory (MACI). High reliability was observed in total score of the MMM (Cronbach α = .86), and high and moderate reliability for each of the five factors obtained in the factorial analysis of the MMM, Social = .82, Enhancement = .72, Coping = .83, Expansion = .74, and Conformity = .64. Significant correlations were also observed between cannabis consumption motives and subjective effects, and between consumption motives and personality. The Spanish version of the MMM shows a similar factorial structure as the one obtained by the original author, and its measures are reliable and valid for the study of cannabis consumption motives in adolescent consumer population.

Body Disapproval as a Mediator of the Relationship Between Risk Factors and Eating Disordered Behaviors Among American Adjudicated Male Youth

This study explores the complex relationships between risk factors (i.e., body disapproval, substance abuse, childhood sexual abuse, and exposure to pornography) and eating disordered behaviors (EDB) among male youth adjudicated for sexual and nonsexual crimes in the USA. This study used cross-sectional design. Survey data were collected from 800 adjudicated male youth. EDB and risk factors were measured using the Millon Adolescent Clinical Inventory and the Childhood Trauma Questionnaire. Path analysis within a structural equation model (SEM) was used to investigate the mediated effects of body disapproval on relationships between risk factors and EDB. Results revealed that body disapproval, substance abuse, childhood sexual abuse, and pornography exposure were significantly related to EDB. Body disapproval mediated the effects of substance abuse, childhood sexual abuse, and pornography exposure on EDB among all adjudicated male youth. Findings suggested that body disapproval maybe an important link in the effects of early risk factors on EDB.

Eating disorders during the adolescence: personality characteristics associated with anorexia and bulimia nervosa.

Previous studies provide relevant information about the relationship between personality and eating disorders (ED). The involvement of personality factors in the etiology and maintenance of ED indicates the need of emphasizing the study of the adolescent's personality when diagnosed of ED. The aims of this study were to analyze the adolescent's personality profiles that differ significantly in anorexia nervosa (AN) and bulimia nervosa (BN), and to explore the most common profiles and their associations with those subtypes of eating disorders (ED). A total of 104 patients with AN and BN were studied by means of the Millon Adolescent Clinical Inventory (MACI). The personality profiles that differ significantly in both AN and BN were submissive, egotistic, unruly, forceful, conforming, oppositional, self-demeaning and borderline. The most frequent profiles in AN were conforming (33.33%), egotistic (22.72%) and dramatizing (18.18%) while in the case of BN those profiles were unruly (18.42%), submissive (18.42%) and borderline (15.78%). We did not find any associations between the diagnostic subgroup (AN, BN) and the fact of having personality profiles that could become dysfunctional. Bearing in mind these results, it may be concluded that there are relevant differences between personality profiles associated with AN and BN during adolescence, so tailoring therapeutic interventions for this specific population would be important.

The Impact of Careless and Random Responding on Juvenile Forensic Assessment: Susceptibility of Commonly Used Measures and Implications for Research and Practice

ABSTRACTForensic assessment experts and practice guidelines strongly endorse appraisal of response styles that can distort psychological assessment results and lead to serious interpretive errors, including careless and random responding (C/RR). Little attention has been directed to the implications of C/RR for juvenile forensic mental health assessment. To address this gap in the literature, we reviewed frequently used measures in juvenile forensic assessment. We found that many such measures do not include built-in checks for detecting C/RR. We then conducted simulation studies examining two frequently used measures, one without a built-in check for C/RR and one with such a scale: the Youth Self-Report (YSR) and the Millon Adolescent Clinical Inventory (MACI), respectively. Results indicated that random responding substantially influenced scores on the YSR, raising most scales well above normative levels, yet often producing protocols that seemed genuine. On the MACI, random responding was undetected 25% of the time and another 50% of the time appears to yield computer-based reports that do not explicitly reject the test results as invalid. Taken together, these simulations suggest that randomly generated assessment protocols may often be mistaken for genuine results. Implications for both practitioners and applied researchers involved in juvenile forensic assessment are discussed.

Internalizing and externalizing personality and subjective effects in a sample of adolescent cannabis users.

Cannabis is the illicit substance most widely used by adolescents. Certain personality traits such as impulsivity and sensation seeking, and the subjective effects experienced after substance use (e.g. euphoria or relaxation) have been identified as some of the main etiological factors of consumption. This study aims to categorize a sample of adolescent cannabis users based on their most dominant personality traits (internalizing and externalizing profile). Then, to make a comparison of both profiles considering a set of variables related to consumption, clinical severity and subjective effects experienced. From a cross-sectional design, 173 adolescents (104 men and 69 women) aged 13 to 18 asking for treatment for cannabis use disorder in an Addictive Behavior Unit (UCAD) from the hospital were recruited. For the assessment, an ad hoc protocol was employed to register consumption, the Millon Adolescent Clinical Inventory (MACI) and the Addiction Research Center Inventory (ARCI) 49-item short form were also administered. Factor analysis suggested a two-profile solution: Introverted, Inhibited, Doleful, Dramatizing (-), Egotistic (-), Self-demeaning and Borderline tendency scales composed the internalizing profile, and Submissive (-), Unruly, Forceful, Conforming (-) and Oppositional scales composed the externalizing profile. The comparative analysis showed that the internalizing profile has higher levels of clinical severity and more subjective effects reported than the externalizing profile. These results suggest the need to design specific intervention strategies for each profile.

HIV risk behavior and internalizing/externalizing psychopathology among adolescents in court-ordered treatment

ABSTRACTBackground: The confluence of drug use behaviors, sexual risk, and psychopathology may complicate human immunodeficiency virus (HIV) prevention intervention for adolescents engaging in substance use and criminal behavior. However, few studies have examined these risk associations. Objective: This study identified HIV risk behavior subgroups among adolescents in court-ordered substance abuse treatment and examined linkages with dimensions of internalizing and externalizing psychopathology. Methods: Internalizing and externalizing behaviors were assessed with the Millon Adolescent Clinical Inventory (MACI). Latent class analysis was used to identify subgroups on the basis of involvement in substance use proximal to sex, number of partners, and consistency of condom use. Results: Participants (n = 301) were identified as demonstrating high, medium, or low levels of sexual risk behavior. Greater externalizing psychopathology distinguished the high risk class from the medium risk class and from the low risk class. Conclusion: Detained youth with particularly serious oppositional-defiant behavioral characteristics, substance use, and sex risk behavior likely require intensive interventions that address the multiple systemic factors that contribute to the development and maintenance of this pattern.