Laura Stoppelbein

Proactive and Reactive Aggression in a Child Psychiatric Inpatient Population

This study examined relations between proactive and reactive aggression and indicators of antisocial behavior (callous/unemotional traits and behavioral consequences) and negative affect (depression and suicidal behavior) in a sample of 105 children admitted to an acute child psychiatric inpatient unit. The majority of the children were male (69%) and ranged from 6 to 12 years of age (M = 9.61, SD = 1.83). Multiple regression analyses revealed that proactive aggression was a unique predictor of antisocial behavior but was not significantly related to negative affect. In contrast, reactive aggression was uniquely positively related to negative affect but unrelated to indicators of antisocial behavior. Findings support unique correlates for proactive and reactive aggression.

Etiopathogenesis of Catatonia: Generalizations and Working Hypotheses

Catatonia has been rediscovered over the last 2 decades as a unique syndrome that consists of specific motor signs with a characteristic and uniform response to benzodiazepines and electroconvulsive therapy. Further inquiry into its developmental, environmental, psychological, and biological underpinnings is warranted. In this review, medical catatonia models of motor circuitry dysfunction, abnormal neurotransmitters, epilepsy, genetic risk factors, endocrine dysfunction, and immune abnormalities are discussed. Developmental, environmental, and psychological risk factors for catatonia are currently unknown. The following hypotheses need to be tested: neuroleptic malignant syndrome is a drug-induced form of malignant catatonia; Prader-Willi syndrome is a clinical GABAergic genetic-endocrine model of catatonia; Kleine-Levin syndrome represents a periodic form of adolescent catatonia; and anti-N-methyl-d-aspartate receptor encephalitis is an autoimmune type of catatonia.

Pathways to suicidal behaviors in childhood.

Path analyses were applied to test a model that includes internalizing and externalizing behavior problems as predictors of suicidal behaviors in children. Parents of an inpatient sample of boys (N=87; M age=9.81 years) rated the frequency of suicidal ideation and completed standardized measures of behavior problems. Blind raters rated the severity of the childrens suicidal behaviors. Results revealed a significant direct effect for suicidal ideation on suicide attempt and for depressive symptoms on suicidal ideation. There was also a significant indirect path from impulsivity to suicidal ideation through aggressive and depressive symptoms. Clinical implications are discussed.

Proactive and Reactive Aggression in a Child Psychiatric Inpatient Population Relations to Psychopathic Characteristics

The study examined relations between caregiver- and child-reported proactive and reactive aggression and psychopathic characteristics (callous/unemotional traits, narcissism, and impulsivity) in a sample of 105 children (69% male) ranging from 6 to 12 years of age (M = 9.61, SD = 1.83) who were admitted to a child psychiatric inpatient facility. Caregiver reports of aggression suggested that proactive and reactive aggression were similarly related to callous/unemotional traits and narcissism but that only reactive aggression was associated with impulsivity. In contrast, child reports of proactive aggression, but not reactive aggression, were associated with all three psychopathic characteristics. Theoretical and clinical implications are discussed.

Factor analysis of the Pediatric Symptom Checklist with a chronically ill pediatric population.

ABSTRACT. The psychometric properties and factor structure of a widely used screening measure for behavioral and emotional dysfunction, the Pediatric Symptom Checklist (PSC), was extended to a population of chronically ill children. Parents of 404 children ranging from 6 to 17 years of age and diagnosed with either insulin-dependent diabetes mellitus (IDDM) or sickle cell disease (SCD) completed the PSC while waiting for a routine medical appointment. The measures internal consistency was found to be high, Cronbachs alpha = .89, and test-retest reliability across 4 months was observed to be acceptable, r = .77. A principal components analysis with an oblique (promax) rotation yielded a four-factor solution with factors that included items representative of internalizing, externalizing, attention, and chronic illness-related problems, respectively. Cronbach alpha estimates ranged from .78 to .83 for the first three factors but was lower for the chronic illness-related problems factor (Cronbachs alpha = .60). A three-factor solution and reliability estimates were recomputed without the chronic illness items that yielded the same reliability estimates for each of the three factors and for the full scale. The three-factor solution was also found to be similar to a published factor structure obtained with a primary care sample, rc = .90-.91. The findings lend support to extending the PSCs clinical utility to tertiary care pediatric settings. Further research is recommended with a broader range of chronic illness groups to increase generalizability.

Confirmatory factor analysis of the antisocial process screening device with a clinical inpatient population

Research linking psychopathic tendencies to childhood behavior problems is predicated on the assumption that the findings are based on using psychometrically sound measures of psychopathic tendencies. Although evaluated with community samples, the psychometric properties of such measures have not been evaluated with inpatient clinical populations thereby limiting conclusions. Hence, the goal of the present study was to evaluate the factor structure of a widely used measure—the Antisocial Process Screening Device (APSD)—with an inpatient population. Parents of 328 children (M age = 8.90 years) completed the APSD at the time of their childs admission for treatment. Although confirmatory factor analyses supported the three- and two-factor solutions proposed by the authors of the measure, the two-factor structure was more parsimonious. Factors of the two-factor model were also related to symptoms of childhood behavior disorders. The findings extend current research on the APSDs factor structure to an inpatient population.

Relation between parenting stress and psychopathic traits among children.

Parenting stress was examined as a correlate of psychopathic traits, specifically narcissism, callous/unemotional traits, and impulsivity, among school-aged children while controlling for the variance explained by aggressive behavior. Participants included 212 children ranging from 6 to 12 years of age (M = 8.3 years) who were admitted to an acute child psychiatric inpatient unit for treatment. Parents completed standardized measures of aggression (Child Behavior Checklist; CBCL), psychopathic traits (Antisocial Process Screening Device; APSD), and parenting stress (Parenting Stress Index; PSI) at the time of the childs admission. Multiple regression analyses revealed that high levels of the PSI dimension attachment difficulties were associated with high levels of narcissism and callous/unemotional traits among the children while statistically controlling for aggression. The PSI dimension role restriction was also found to be negatively related to narcissism. These findings suggest that specific aspects of parenting stress may be related to child psychopathic traits and might aid with conceptualizing and developing treatment approaches for childhood behavior problems.

Aggression and the Risk for Suicidal Behaviors among Children

Two subtypes of aggression--reactive and proactive--were examined to see how they relate to suicidal behaviors among young children admitted for acute psychiatric inpatient care. The children and their parents completed self-report questionnaires/interviews. Regression analyses revealed that depressed girls who scored higher on reactive aggression reported more suicidal behaviors; whereas proactive aggression did not relate to suicidal behaviors for either boys or girls.

Child Internalizing and Externalizing Behavior as Predictors of Age at First Admission and Risk for Repeat Admission to a Child Inpatient Facility

Gaining a better understanding of the types of child symptomatology that predict age at first admission and risk for readmission to a child psychiatric inpatient facility could help to inform the focus of intervention. Accordingly, the current study examined whether internalizing and externalizing behavior problems, alone or in combination, were associated with age at first admission and risk for repeat admission. Analyses were based on a sample of 372 children (M = 9.13 years, SD = 1.91) admitted to an acute psychiatric inpatient facility. Internalizing behavior was associated with a later age at admission, but unrelated to repeat admission. Externalizing behavior was associated with an earlier age at admission and increased risk for repeat admission. Co-occurring internalizing and externalizing behavior problems were associated with increased risk for repeat admission, but were unrelated to age at first admission. Implications for findings are discussed.

Factor Analyses of the Pediatric Symptom Checklist-17 With African-American and Caucasian Pediatric Populations

OBJECTIVES To validate a three-factor model for the Pediatric Symptom Checklist-17 (PSC-17) and evaluate its diagnostic accuracy with African-American and Caucasian children with and without a chronic illness. METHODS Mothers of 723 youth diagnosed with either type I diabetes (n = 210) or sickle cell disease (n = 191) and a nonill peer group (n = 322) completed a demographic questionnaire, the PSC-17, and the Child Behavior Checklist (CBCL). RESULTS Confirmatory factor analyses and tests of measurement invariance validated a three-factor structure for the PSC-17 with African-American and Caucasian youth with and without a chronic illness. Receiver operating characteristic curves revealed optimal cut-off scores that are similar to published reports. CONCLUSIONS A three-factor solution was replicated for the PSC-17 with African-American and Caucasian children with and without a chronic illness. Cut-off scores for identifying children at risk for emotional/behavioral problems were evaluated using the CBCL as the gold standard and are discussed.