Dustin A. Pardini

Callous/Unemotional Traits and Social-Cognitive Processes in Adjudicated Youths

OBJECTIVE There seem to be two dimensions associated with psychopathic traits in youths: a callous/unemotional factor (C/U) and an impulsivity/conduct problems factor (I/CP). This study sought to clarify the nature of these two factors and examine their relation with social-cognitive problems in incarcerated adolescents. METHOD One hundred sixty-nine male and female adjudicated youths were recruited for participation. Self-report measures and archival data were used to assess psychopathic traits, emotional distress, behavioral dysregulation, social-cognitive processes, and delinquency severity. RESULTS Analyses demonstrated that the I/CP factor is associated with increased levels of dysregulated behavior, while the C/U dimension is related to deficits in empathy. The two factors exhibited differential relations with measures of emotional distress and fearfulness. C/U traits were associated with an increased focus on the positive aspects of aggression and a decreased focus on the negative aspects of hostile acts. Findings remained after controlling for demographic characteristics, abuse history, intellectual abilities, and delinquency severity. CONCLUSIONS Results provide support for the two-dimensional nature of psychopathy in youths and suggest that C/U traits are associated with lower emotional distress and a specific social information-processing pattern. The potential implications for working with adjudicated youths exhibiting C/U traits are noted.

Measurement of Symptoms Following Sports-Related Concussion: Reliability and Normative Data for the Post-Concussion Scale

It is important to carefully evaluate self-reported symptoms in athletes with known or suspected concussions. This article presents data on the psychometric and clinical properties of a commonly used concussion symptom inventory-the Post-Concussion Scale. Normative and psychometric data are presented for large samples of young men (N = 1,391) and young women (N = 355). In addition, data gathered from a concussed sample of athletes (N = 260) seen within 5 days of injury are presented. These groups represent samples of both high school and collegiate athletes. Data from a subsample of 52 concussed athletes seen 3 times post-injury are presented to illustrate symptom reporting patterns during the initial recovery period. General guidelines for the clinical use of the scale are provided.

Reciprocal Relationships Between Parenting Behavior and Disruptive Psychopathology from Childhood Through Adolescence

Theoretical models suggest that child behaviors influence parenting behaviors, and specifically that unpleasant child behaviors coerce parents to discontinue engaging in appropriate discipline. This study examined reciprocal relationships between parenting behaviors (supervision, communication, involvement, timid discipline and harsh punishment) and child disruptive disorder symptoms (ADHD, ODD and CD) in a clinic-referred sample of 177 boys. Annual measures, including structured clinical interviews, were obtained from the beginning of the study (when boys were between the ages of 7 to 12) to age 17. Specific reciprocal influence was observed; only timid discipline predicted worsening behavior, namely ODD symptoms, and ODD symptoms predicted increases in timid discipline. Greater influence from child behaviors to parenting practices was found: ODD also predicted poorer communication and decreased involvement, and CD predicted poorer supervision. ADHD was neither predictive of, nor predicted by, parenting behaviors. The results are specifically supportive of a coercive process between child behaviors and parenting behaviors, and generally suggestive of greater influence of child behaviors on parenting behaviors than of parenting behaviors on child behaviors

The Development of Callous-Unemotional Traits and Antisocial Behavior in Children: Are There Shared and/or Unique Predictors?.

Callous and unemotional (CU) traits have been linked to severe antisocial behavior in youth, but studies examining the etiology of CU traits are lacking. Based on prior research, it was hypothesized that childhood anxiety and parenting practices would interact to predict changes in CU traits over time. Hypotheses were tested using a sample of 120 moderate to highly aggressive fifth graders followed over a 1-year period. Although CU traits displayed moderate temporal stability and predicted increases in antisocial behavior, evidence suggested that these features were not immutable. Children exposed to lower levels of physical punishment showed decreases in CU traits over time, whereas higher levels of child-reported parental warmth and involvement predicted decreases in both CU traits and antisocial behavior over time. Lower levels of anxiety were uniquely related to increased CU traits for children who described their primary caregiver as exhibiting low warmth and involvement.

The prediction of violence and homicide in young men.

In this prospective study, the authors predicted violence and homicide in 3 representative school samples (N = 1,517). Participants were part of a longitudinal, multiple cohort study on the development of delinquency in boys from late childhood to early adulthood in Pittsburgh, Pennsylvania. Thirty-three participants were convicted of homicide, 193 participants were convicted of serious violence, whereas another 498 participants self-reported serious violence. Predictors of violence included risk factors in the domains of child, family, school, and demographic characteristics. Boys with 4 or more violence risk factors were 6 times more likely to later commit violence in comparison with boys with fewer than 4 risk factors (odds ratio [OR] = 6.05). A subset of risk factors related to violence also predicted homicide among violent offenders. Boys with 4 or more risk factors for homicide were 14 times more likely to later commit homicide than violent individuals with fewer than 4 risk factors (OR = 14.48). Implications for the prevention of violence and homicide are discussed.

Religious faith and spirituality in substance abuse recovery: determining the mental health benefits.

Recently, mental health professionals have begun examining the potential value of religious faith and spirituality in the lives of individuals suffering from a variety of acute and chronic illnesses. This study explored the relation between religious faith, spirituality, and mental health outcomes in 236 individuals recovering from substance abuse. We found that recovering individuals tend to report high levels of religious faith and religious affiliation, but choose to rate themselves as being more spiritual than religious. Results also indicate that among recovering individuals, higher levels of religious faith and spirituality were associated with a more optimistic life orientation, greater perceived social support, higher resilience to stress, and lower levels of anxiety. This represents the largest self-report study to date examining the relation between religious faith, spirituality, and mental health outcomes among individuals recovering from substance abuse.

Impact of the Method of Initial Stabilization for Femoral Shaft Fractures in Patients With Multiple Injuries at Risk for Complications (Borderline Patients)

Objectives:The timing of definitive fixation for major fractures in patients with multiple injuries is controversial. To address this gap, we randomized patients with blunt multiple injuries to either initial definitive stabilization of the femur shaft with an intramedullary nail or an external fixateur with later conversion to an intermedullary nail and documented the postoperative clinical condition. Methods:Multiply injured patients with femoral shaft fractures were randomized to either initial (<24 hours) intramedullary femoral nailing or external fixation and later conversion to an intramedullary nail. Inclusion: New Injury Severity Score >16 points, or 3 fractures and Abbreviated Injury Scale score ≥2 points and another injury (Abbreviated Injury Scale score ≥2 points), and age 18 to 65 years. Exclusion: patients in unstable or critical condition. Patients were graded as stable or borderline (increased risk of systemic complications). Outcomes:Incidence of acute lung injuries. Results:Ten European Centers, 165 patients, mean age 32.7 ± 11.7 years. Group intramedullary nailing, n = 94; group external fixation, n = 71. Preoperatively, 121 patients were stable and 44 patients were in borderline condition. After adjusting for differences in initial injury severity between the 2 treatment groups, the odds of developing acute lung injury were 6.69 times greater in borderline patients who underwent intramedullary nailing in comparison with those who underwent external fixation, P < 0.05. Conclusion:Intramedullary stabilization of the femur fracture can affect the outcome in patients with multiple injuries. In stable patients, primary femoral nailing is associated with shorter ventilation time. In borderline patients, it is associated with a higher incidence of lung dysfunctions when compared with those who underwent external fixation and later conversion to intermedullary nail. Therefore, the preoperative condition should be when deciding on the type of initial fixation to perform in patients with multiple blunt injuries.

Development and Etiology of Disruptive and Delinquent Behavior

This review examines the development and etiology of disruptive behavior [symptoms of oppositional defiant disorder (ODD), conduct disorder (CD), and psychopathic features] and delinquency (particularly violence). We address selected key developmental issues, including (a) to what extent negative emotional ODD symptoms are associated with later internalizing disorders, (b) whether psychopathic features provide added predictive utility beyond traditional disruptive behaviors, and (c) the role of oppositional behavior and conduct problems in the development of violence. This review also focuses on the causes of ODD, CD, psychopathic features, and delinquency and explores the extent to which the causes of disruptive and delinquent behavior are the same. We examine the degree to which risk and promotive factors change with age and whether promotive factors buffer the impact of risk factors. Finally, we explore the question of whether there are developmental shifts in childrens exposure to risk and promotive factors.

Symptoms of Conduct Disorder, Oppositional Defiant Disorder, Attention-Deficit/Hyperactivity Disorder, and Callous-Unemotional Traits as Unique Predictors of Psychosocial Maladjustment in Boys: Advancing an Evidence Base for DSM-V

OBJECTIVE The incremental utility of symptoms of conduct disorder (CD), oppositional defiant disorder (ODD), attention-deficit/hyperactivity disorder (ADHD), and callous-unemotional (CU) traits for predicting psychosocial outcomes across multiple domains was examined in a community sample of 1,517 boys. METHOD Several outcomes were assessed semiannually across a 2-year follow-up, including antisocial behavior, internalizing problems, peer conflict, and academic difficulties. Official criminal charges were also examined across adolescence. RESULTS CD symptoms emerged as the most robust predictor of future antisocial outcomes. However, ODD symptoms predicted later criminal charges and conduct problems, and CU traits were robustly associated with serious and persistent criminal behavior in boys. Attention-deficit/hyperactivity disorder symptoms predicted increases in oppositional defiant behavior and conduct problems over time and were uniquely related to future academic difficulties. Both ADHD and ODD symptoms predicted social and internalizing problems in boys, whereas CU traits were associated with decreased internalizing problems over time. CONCLUSIONS The current findings have implications for revisions being considered as part of the DSM-V. Specifically, incorporating CU traits into the diagnostic criteria for Disruptive Behavior Disorders (DBD) may help to further delineate boys at risk for severe and persistent delinquency. Although currently prohibited, allowing a diagnosis of ODD when CD is present may provide unique prognostic information about boys who are at risk for future criminal behavior, social problems, and internalizing problems.

Novel Insights into Longstanding Theories of Bidirectional Parent–Child Influences: Introduction to the Special Section

Although bidirectional parent and child influences have been incorporated in theoretical models pertaining to the development of internalizing and externalizing behaviors in youth, studies have historically focused on the socializing influence that parents have on their children. This has left several important research questions unanswered about the nature of bidirectional parent–child relations across development, including how these bidirectional effects are related to different types of child and adolescent psychopathology. The goal of this special section is to examine some longstanding issues regarding the nature of bidirectional parent–child effects across time using a diverse array of longitudinal datasets. The results from these studies emphasize the importance of considering bidirectional effects in developmental psychopathology research, particularly the often overlooked influence that children and adolescents have on their parents’ behavior and emotional well-being. Following these empirical articles, an expert in the field provides a scholarly commentary designed to outline the progress that has been made in understanding bidirectional parent–child effects across development as well as to propose fruitful areas for future research.