Katharina Ackermann

Community Violence Exposure and Conduct Problems in Children and Adolescents with Conduct Disorder and Healthy Controls

Exposure to community violence through witnessing or being directly victimized has been associated with conduct problems in a range of studies. However, the relationship between community violence exposure (CVE) and conduct problems has never been studied separately in healthy individuals and individuals with conduct disorder (CD). Therefore, it is not clear whether the association between CVE and conduct problems is due to confounding factors, because those with high conduct problems also tend to live in more violent neighborhoods, i.e., an ecological fallacy. Hence, the aim of the present study was: (1) to investigate whether the association between recent CVE and current conduct problems holds true for healthy controls as well as adolescents with a diagnosis of CD; (2) to examine whether the association is stable in both groups when including effects of aggression subtypes (proactive/reactive aggression), age, gender, site and socioeconomic status (SES); and (3) to test whether proactive or reactive aggression mediate the link between CVE and conduct problems. Data from 1178 children and adolescents (62% female; 44% CD) aged between 9 years and 18 years from seven European countries were analyzed. Conduct problems were assessed using the Kiddie-Schedule of Affective Disorders and Schizophrenia diagnostic interview. Information about CVE and aggression subtypes was obtained using self-report questionnaires (Social and Health Assessment and Reactive-Proactive aggression Questionnaire (RPQ), respectively). The association between witnessing community violence and conduct problems was significant in both groups (adolescents with CD and healthy controls). The association was also stable after examining the mediating effects of aggression subtypes while including moderating effects of age, gender and SES and controlling for effects of site in both groups. There were no clear differences between the groups in the strength of the association between witnessing violence and conduct problems. However, we found evidence for a ceiling effect, i.e., individuals with very high levels of conduct problems could not show a further increase if exposed to CVE and vice versa. Results indicate that there was no evidence for an ecological fallacy being the primary cause of the association, i.e., CVE must be considered a valid risk factor in the etiology of CD.

Association of trauma, Posttraumatic Stress Disorder and Conduct Disorder: A systematic review and meta-analysis

Objective: To summarize findings of previous studies on the prevalence of trauma and Posttraumatic Stress Disorder (PTSD) in Conduct Disorder (CD). Method: We conducted a systematic review and meta‐analysis following the PRISMA guidelines. EBSCOhost, PubMed, CDSR and ARIF databases were searched in October 2016, employing relevant keywords. Results: 19 studies met inclusion criteria. Meta‐analysis resulted in a lifetime PTSD prevalence of 11% (95% CI: 7–17%) in children and adolescents with CD, 14% (95% CI: 12–15%) in adults with pre‐existing CD and 32% (95% CI: 25–40%) in juvenile offenders with CD. Higher lifetime PTSD prevalence was observed in individuals with than without CD, and in females compared to males with CD. Conclusions: Studies focusing on the association of trauma, PTSD and CD are still relatively rare. Possible comorbidity models are discussed considering psychological and biological risk factors in a comprehensive model. The high rate of PTSD in CD may be due to shared risk factors; furthermore, CD might increase the risk for comorbid PTSD due to CD inherent risk taking behavior. To study pathways of risk, especially longitudinal studies are necessary. HIGHLIGHTSStudies focusing on trauma and PTSD in CD are still relatively scarce.Individuals with CD compared to non‐CD experience specific and multiple traumata.Increased lifetime PTSD prevalence was found in individuals with CD.Females with CD show a higher lifetime prevalence of PTSD than males with CD.Sophisticated longitudinal studies are needed to clarify specific models of comorbidity.

START NOW - a comprehensive skills training programme for female adolescents with oppositional defiant and conduct disorders: study protocol for a cluster-randomised controlled trial

BackgroundIn Europe, the number of females exhibiting oppositional defiant disorder (ODD) and conduct disorder (CD) is growing. Many of these females live in youth welfare institutions. Consequently, there is a great need for evidence-based interventions within youth welfare settings. A recently developed approach targeting the specific needs of girls with ODD and CD in residential care is START NOW. The aim of this group-based behavioural skills training programme is to specifically enhance emotional regulation capacities to enable females with CD or ODD to appropriately deal with daily-life demands. It is intended to enhance psychosocial adjustment and well-being as well as reduce oppositional and aggressive behaviour. We present the study protocol (version 4.1; 10 February 2016) of the FemNAT-CD intervention trial titled ‘Group-Based Treatment of Adolescent Female Conduct Disorders: The Central Role of Emotion Regulation’.Methods/designThe study is a prospective, confirmatory, cluster-randomised, parallel-group, multi-centre, randomised controlled trial with 128 institutionalised female adolescents who fulfil the diagnostic criteria of ODD and/or CD. Institutions/wards will be randomised either to provide the 12-week skills training as an add-on intervention or to provide treatment as usual. Once the first cycle is completed, each institution will run a second cycle with the opposite condition. Primary endpoints are the pre-post change in number of CD/ODD symptoms as assessed by a standardised, semi-structured psychiatric interview (Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children–Present and Lifetime, CD/ODD section) between baseline and the end of intervention, as well as between baseline and a 3-month follow-up point. Secondary objectives include pre-post change in CD/ODD-related outcome measures, most notably emotional regulation on a behavioural and neurobiological level after completion of START NOW compared with treatment as usual.DiscussionTo our knowledge, this study is the first to date to systematically investigate the effectiveness of an adapted integrative psychosocial intervention designed for female adolescents with ODD and CD in youth welfare settings.Trial registrationGerman Clinical Trials Register (DRKS) identifier: DRKS00007524. Registered on 18 December 2015 and with the World Health Organisation International Clinical Trials Registry Platform.

Aggression modulates neural correlates of hostile intention attribution to laughter in children

&NA; The tendency to interpret nonverbal social signals as hostile in intention is associated with aggressive responding, poor social functioning and mental illness, and can already be observed in childhood. To investigate the neural correlates of such hostile attributions of social intention, we performed a functional magnetic imaging study in 10–18 year old children and adolescents. Fifty healthy participants rated videos of laughter, which they were told to imagine as being directed towards them, as friendly versus hostile in social intention. Hostile intention ratings were associated with neural response in the right temporal voice area (TVA). Moreover, self‐reported trait physical aggression modulated this relationship in both the right TVA and bilateral lingual gyrus, with stronger associations between hostile intention ratings and neural activation in children with higher trait physical aggression scores. Functional connectivity results showed decreased connectivity between the right TVA and left dorsolateral prefrontal cortex with increasing trait physical aggression for making hostile social intention attributions. We conclude that childrens social intention attributions are more strongly related to activation of early face and voice‐processing regions with increasing trait physical aggression. HighlightsHostile attributions increase with temporal voice area response to laughter.Aggression modulates strength of neural correlates of social intention attribution.Modulation specific to early face (lingual) and voice (temporal) processing regions.Attribution‐dependent fronto‐temporal connectivity decreases with physical aggression.

Adolescent oxytocin response to stress and its behavioral and endocrine correlates

ABSTRACT Oxytocin (OXT) shows anxiolytic and stress‐reducing effects, but salivary OXT response to laboratory‐induced stress has only been assessed in one study in healthy adults. The present study aimed at extending these findings by assessing salivary OXT stress reactivity in healthy adolescents (aged 11–18) compared to a control condition. A higher salivary OXT response to stress compared to the control condition was expected. In addition, the association between OXT, cortisol (CORT) and psychological reactivity patterns was explored. Psychosocial stress was induced using the Trier Social Stress Test (TSST; 13 males, 15 females), while the Control‐TSST (14 males, 15 females) served as a non‐stress control condition. Salivary OXT increased in response to the TSST with a peak at +1 and decline at +10min after stress. Baseline OXT correlated negatively with experienced anxiety and insecurity, while both correlated positively with OXT reactivity. OXT and CORT increase as well as OXT increase and CORT recovery were positively correlated. Results indicate that salivary OXT in response to the TSST is a valid method to assess biological effects of laboratory‐induced stress also in adolescents. Due to a rapid increase and decline, salivary OXT needs to be assessed directly after stress exposure. Given the interplay of OXT with affective symptoms and CORT response, the combined measure of salivary OXT and CORT reactivity adds to studying stress reactivity in typically developing and clinical samples. HIGHLIGHTSSalivary oxytocin (OXT) is responsive to stress in healthy adolescents.Salivary OXT needs to be assessed soon after the stress task due to fast increase.Salivary OXT peaked and returned to baseline levels earlier than salivary cortisol.OXT and cortisol appear to be co‐activated in response to stress.High baseline OXT levels were related to low anxiety and insecurity feelings.

Reactivity of oxytocin in the Trier Social Stress Test: A proof of concept study

High and lowfitwomen (n=22 per group; in the follicular phase of themenstrual cycle)were subjected to a TSST (Kirschbaum, Pirke et al., 1993) at 1500h. Blood sampleswere collectedevery7–15min from 1400h–1700h for the measurement of concentrations of cortisol, Adr, NA and dopamine (DA)whichwere comparedwithin and between groups using repeated measures ANOVA. Maximumoxygen consumption (VO2max)was higher (p<0.001) in high fit women (41.9±1.6ml/kgmin) compared with low fit women (27.4±1.0ml/kgmin). Both groups responded to the TSST with a substantial elevation of cortisol (107%; p<0.001), Adr (146%; p<0.002), NA (92%; p<0.001) and DA (44%; p<0.001) but this response did not differ significantly between high and low fit women (time * treatment for cortisol, Adr, NA and DA; p=0.987, p=0.118, p=0.169, p=0.392, respectively). For DA, reactivity was higher (p=0.009) in the low fit women compared with the high fit women. The response to psychosocial stress in both groups of women was substantial and robust and was not readily perturbed by differences in fitness levels.