Neuropsychological Characterization of Aggressive Behavior in Children and Adolescents with CD/ODD and Effects of Single Doses of Medications: The Protocol of the Matrics_WP6-1 Study

Aggressive behaviors and disruptive/conduct disorders are some of the commonest reasons for referral to youth mental health services; nevertheless, the efficacy of therapeutic interventions in real-world clinical practice remains unclear. In order to define more appropriate targets for innovative pharmacological therapies for disruptive/conduct disorders, the European Commission within the Seventh Framework Programme (FP7) funded the MATRICS project (Multidisciplinary Approaches to Translational Research in Conduct Syndromes) to identify neural, genetic, and molecular factors underpinning the pathogenesis of aggression/antisocial behavior in preclinical models and clinical samples. Within the program, a multicentre case-control study, followed by a single-blind, placebo-controlled, cross-over, randomized acute single-dose medication challenge, was conducted at two Italian sites. Aggressive children and adolescents with conduct disorder (CD) or oppositional defiant disorder (ODD) were compared to the same age (10–17 y) typically developing controls (TDC) on a neuropsychological tasks battery that included both “cold” (e.g., inhibitory control, decision making) and “hot” executive functions (e.g., moral judgment, emotion processing, risk assessment). Selected autonomic measures (heart rate variability, skin conductance, salivary cortisol) were recorded before/during/after neuropsychological testing sessions. The acute response to different drugs (methylphenidate/atomoxetine, risperidone/aripiprazole, or placebo) was also examined in the ODD/CD cohort in order to identify potential neuropsychological/physiological mechanisms underlying aggression. The paper describes the protocol of the clinical MATRICS WP6-1 study, its rationale, the specific outcome measures, and their implications for a precision medicine approach.

Clinical Characteristics of Personality and Conduct Disorders in Child Patients With Vasovagal Syncope: A Clinical Case-Control Study

Objective: To analyze the clinical characteristics of abnormal personality and conduct disorders (CDs) in pediatric patients with vasovagal syncope (VVS).Methods: In this study, we recruited patients diagnosed with VVS at Children's Heart Center from January 2018 to December 2020. Healthy children were recruited as controls. The Eysenck Personality Questionnaire-Child edition (EPQ-C) and Achenbach Child Behavior Checklist (CBCL) were used for the assessment.Results: One hundred and fifty-one VVS patients and 151 healthy controls were included in this study. Compared with the control group, patients in the VVS group had a higher incidence of abnormal personality and were more prone to suffer from CDs. Moreover, pediatric patients with VVS suffered more events of syncope recurrence if they had CDs.Conclusion: Abnormal personality and CDs are common clinical characteristics in pediatric patients with VVS.

Mental health and nutritional issues: a dual burden among adolescent school going girls of urban and rural Jodhpur

Background: Adolescents constitute 21% of the total population in India. Untreated mental disorders affect a person’s potential to live a fulfilling life and raises the possibility of conduct disorders. Moreover, malnutrition leads to growth retardation and sexual maturation in later life. Thus, this study was undertaken to understand the role of family size, socio-economic status, marital status on mental and nutritional health of adolescent girls in urban and rural Jodhpur.Methods: A descriptive cross-sectional study in three schools each from rural and urban Jodhpur was conducted to include adolescent girls aged 10-19 years. Semi-structured questionnaire was administered to collect demographic and socio-economic data along with DASS-21 and SMFQ for mental health assessment and BMI, waist-hip ratio collected for nutritional health.Results: Depression score ≥10 was observed in 34.3% girls (significantly associated with monthly attendance), anxiety score ≥10 observed in 64.8% (associated with socio-economic class and monthly attendance) and stress score ≥10 observed in 26.2% (associated with monthly attendance). Th e17.4% were thin while 4.7% overweight, significantly associated with location, age group and socio-economic class. The 5% were at increased metabolic risk, associated with non-participation in extra-curricular activities.Conclusions: The study indicated high prevalence of depression, anxiety and stress, nutritional imbalance and risk of metabolic disorders at an early age, that were significantly associated with the low monthly attendance indicating negative impact of such factors on regular education and academic growth. The findings highlight a greater emphasis needed on mental health and nutritional components during the active growth years of adolescent females.

Teachers’ perceptions of their school principal's leadership style and improvement in their students’ performance in specialized schools for students with conduct disorders

We examined the relationship between the school principal's leadership style, as perceived by the school teachers, and improvement in the performance of students with special education needs enrolled in specialized schools for students with conduct disorders. Our motivation originates in the increasing trend in their share within the general population and the premise that this unique population may respond differently to school principal leadership style. Datasets on students’ previous performance, students’ background characteristics, teacher profiles, and school features were collected. In addition, a questionnaire on teachers’ perceptions of their school principal's leadership style was distributed. Datasets were collected from 92 teachers who worked in special education needs public schools that specialized in conduct disorders. Using STATA software, we measured multilevel fixed-effects models. We found that the more the school principal is perceived as a transformational leader, the higher the students’ performance. Additionally, secondary school advantaged students (i.e. having a high level of previous performance, high socioeconomic strata), who are taught by more educated teachers, exhibit higher performance compared with their counterparts. Based on our finding, we recommend that policy makers would consider assigning transformational leaders to low-performing schools. In addition, policy makers may want to allocate extra learning resources and to provide access to learning services to support the disadvantaged students’ learning process.

Forgiveness in the Modulation of Responsibility in a Sample of Italian Adolescents with a Tendency towards Conduct or Obsessive–Compulsive Problems

Although obsessive–compulsive disorder (OCD) and the conduct disorders (CD) express a contrasting symptomatology, they could represent different answers to a common matrix about morality. In the literature, some theoretical models describe people with OCD as individuals who experience high levels of responsibility and guilt. On the other hand, adolescents with a CD are described as if they do not feel guilty at all or consider anti-social purposes as more important than existing moral purposes. The aims of this study were to investigate the role of forgiveness in responsibility and guilt levels and to test whether this putative relation was influenced by tendencies towards obsessive–compulsive problems (OCP) or conduct problems (CP). In total, 231 adolescents aged between 16 and 18 years were self-assessed using a Youth Self-Report, Child Responsibility Attitudes Questionnaire, Heartland Forgiveness Scale, and Test Of Self-Conscious Affect. The results show that self-forgiveness predicted responsibility levels, while guilt was predicted by self-forgiveness and situation-forgiveness. Moreover, mediation analyses revealed that the effects of OCP on responsibility and guilt were mediated by self-forgiveness and situation-forgiveness. Regarding CP, no mediated effects were found. In conclusion, lower proneness to forgive increases responsibility and guilt, and this is particularly evident in subjects with higher levels of OCP.

Conduct Disorders and Aggression

Research digests on conduct disorders and aggression from the March 2019 edition of The Bridge, ACAMH's journal of secondary publication.

Clinical Characteristics and Self-Harm in Forensic Psychiatric Patients

Self-harm, comprising non-suicidal self-injury, and suicide attempts, is a serious and potentially life-threatening behavior that has been associated with poor life quality and an increased risk of suicide. In forensic populations, increased rates of self-harm have been reported, and suicide is one of the leading causes of death. Aside from associations between self-harm and mental disorders, knowledge on self-harm in forensic psychiatric populations is limited. The purpose of this study was to characterize the clinical needs of a cohort of forensic psychiatric patients, including self-harm and possible risk factors thereof. Participants (N = 98) were consecutively recruited from a cohort of forensic psychiatric patients in Sweden from 2016 to 2020. Data were collected through file information, self-reports, and complemented with semi-structured interviews. Results showed that self-harm was common among the participants, more than half (68.4%) of whom had at some point engaged in self-harm. The most common methods of non-suicidal self-injury were banging one's head or fist against a wall or other solid surface and cutting, and the most common method of suicide attempt was hanging. The most prominent functions of non-suicidal self-injury among the participants were intrapersonal functions such as affect regulation, self-punishment, and marking distress. Self-harm in general was associated to neurodevelopmental disorders (p = 0.014, CI = 1.23–8.02, OR = 3.14) and disruptive impulse-control and conduct disorders (p = 0.012, CI = 1.19–74.6, OR = 9.41), with reservation to very wide confidence intervals. Conclusions drawn from this study are that self-harm was highly prevalent in this sample and seems to have similar function in this group of individuals as in other studied clinical and non-clinical groups.

O-076 Neurodevelopmental morbidity in children born after ART: a Nordic register study from the Committee of Nordic ART and Safety (CoNARTaS) group

Study question Does the risk of neurodevelopmental disorders differ between singletons born after various assisted reproductive techniques (ART) and spontaneous conception (SC) until young adulthood? Summary answer ART children had a slightly increased rate of learning and motor functioning disorders, autism spectrum disorders (ASD), and ADHD and conduct disorders. What is known already Studies on the impact of ART on offspring have reported both increased risk and comparable incidences of neurodevelopmental disorders between ART and SC offspring. The most studied neurodevelopmental disorders with ART are autism spectrum disorders (ASD.) There is, however, no consensus on the risk of ASD for ART children. The risk for other neurodevelopmental disorders, like attention-deficit hyperactivity disorders (ADHD) or tic disorder among ART children, is also a debated issue, as studies are scarce. Study design, size, duration A Nordic register-based cohort study including all singleton live births (N = 5 076 444) after ART (n = 116 909) or SC (n = 4 959 535) between 1995 and 2014 in Denmark and Finland, 1995 and 2015 in Sweden; and 2005 and 2015 in Norway. Children with intellectual disability (ICD-10: F70-F79) are excluded. The children are followed up to young adulthood (the year 2014 in Denmark and Finland, and 2015 in Norway and Sweden). Participants/materials, setting, methods Offspring outcomes were defined as following ICD-10 diagnoses: learning and motor functioning disorders (F80-83), ASD (F84), ADHD and conduct disorders (F90-F92), and tic disorders/Tourette (F95). We calculated crude and adjusted hazard ratios (HR) for neurodevelopmental diagnoses using Cox regression. Adjustments were made for the country, maternal age at the delivery, parity, smoking, and maternal psychiatric morbidity. Main results and the role of chance The cumulative incidences of neurodevelopmental disorders in the cohort were 1.74% for F90-F92, 1.40% for F80-83, 0.66% for F84, and 0.22% for F95. In crude Cox-regression ART children had an increased likelihood during the follow-up of being diagnosed with F84 (HR 1.12 [95% CI 1.04-1.21]) and F95 (HR 1.21 [95% CI 1.06-1.38]), but not with F80-83 (HR 1.01 [95% CI 0.96-1.07]) or F90-92 (HR 0.82 [95% CI 0.77-0.86]). After adjustments the likelihood was increased for F80-83 (HR 1.20 [95% CI 1.13-1.27]), F84 (HR 1.12 [95% CI 1.03-1.24]), and F90-92 (HR 1.09 [95% CI 1.04-1.19]), but nor for F95 (HR 1.13 [95% CI 0.99-1.30]). After adjustments, intracytoplasmic sperm injection children compared with in vitro fertilization children had similar likelihood during follow-up for F80-83 (1.06 [95% CI 0.89–1.25]), for F84 (HR 0.92 [95% CI 0.76–1.11]), for F90-92 (HR 0.96 [95% CI 0.83–1.12]), and for F95 (HR 1.16 [95% CI 0.83–1.63]). After adjustments, frozen embryo transfer children compared with fresh embryo transfer children had similar likelihood during follow-up for F80-83 (HR 1.11 [95% CI 0.90–1.37]), F84 (HR 0.98 [95% CI 0.76–1.27]), F90-92 (HR 0.96 [95% CI 0.78–1.19]), and F95 (HR 0.83 [95% CI 0.51–1.35]). Limitations, reasons for caution There may be residual confounding by unknown or unmeasured confounders. We lack information on possible confounders like the reason and length of infertility, maternal substance use other than self-reported smoking status, paternal age, and parental somatic morbidity. Additional limitations are differences in registration practice and data availability between study countries. Wider implications of the findings This is the largest singleton cohort and the first multinational study on the risk for neurodevelopmental disorders among ART children. While the rate of some neurodevelopmental disorders was increased among ART children, the absolute risk was moderate. The type of ART did not associate with the incidence of neurodevelopmental disorders. Trial registration number ISRCTN11780826