Lucres M. C. Jansen

Cortisol moderates the relationship between testosterone and aggression in delinquent male adolescents

BACKGROUND In animals, strong evidence exists for an association between testosterone and aggression. In humans, and particularly in children and adolescents, findings have been less consistent. Previous research has suggested that this may partly be due to moderating effects of other factors, e.g., hormones. This study aims to investigate the moderating effect of cortisol on the relationship between testosterone and subtypes of aggression in delinquent male adolescents. METHODS Participants were 103 boys (mean age 13.7) referred to a delinquency diversion program. Testosterone and cortisol levels were determined from saliva samples collected during resting conditions and related to self-report scores on overt and covert aggression. RESULTS Linear regression analyses revealed a significant interaction between cortisol and testosterone in relation to overt aggression, with a significant positive relationship between testosterone and overt aggression in subjects with low cortisol levels but not in subjects with high cortisol levels. Using the same model for covert aggression, no significant effects of testosterone, cortisol, or testosterone x cortisol interaction were found. CONCLUSIONS These results indicate a moderating effect of cortisol on the relationship between testosterone and overt aggression in delinquent male adolescents. Implications and directions for future research are discussed.

Hypothalamus pituitary adrenal axis and autonomic activity during stress in delinquent male adolescents and controls

OBJECTIVE Patterns of low autonomic arousal have consistently been related to delinquency and disruptive behavior disorders (DBD) in children and adolescents. Findings on another stress regulating mechanism, the hypothalamic pituitary adrenal (HPA) axis, have been inconsistent, which may partly be due to not considering specific stress reactivity measures. Therefore, the aim of the present study was to investigate the relationship between disruptive behavior in male adolescents and their HPA and autonomic reactivity to a standard public speaking task (PST). METHOD Responsivity to the PST of cortisol, heart rate (HR), skin conductance level (SCL) and self-reported negative feelings was measured, and compared between 12and14-year-old boys who attended a delinquency diversion program (DP), with and without DBD (DP+, n=22 and DP-, n=49, resectively), and matched normal controls (NC, n=30). DBD diagnoses were based on a structured psychiatric interview. RESULTS The DP+ group, but not the DP- group, showed a significantly decreased cortisol and HR response during the PST as compared with the NC group. No significant effects were found for SCL. All subjects connoted the task negatively. CONCLUSIONS The results indicate that low cortisol and HR responsivity to stress may be a neurobiological marker for delinquent boys with DBD, but not for those without DBD. Directions for future research and clinical implications are discussed.

Unresponsiveness to psychosocial stress in a subgroup of autistic-like children, Multiple Complex Developmental Disorder

In this study, we tried to replicate the finding of a diminished cortisol response to stress in autistic-like patients in a more homogenous Multiple Complex Developmental Disorder (MCDD) group. MCDD forms a distinct group within the autistic-like disorders, characterized by impaired regulation of anxiety and affective state, impaired social behavior/sensitivity, and thought disorder. A number of MCDD children develop schizophrenia in adult life. Responses to a psychosocial stressor, consisting of speaking in public while recorded on video, were measured in 10 MCDD children and 12 healthy control children. The public speaking test was imbedded in a two-hour test session, and compared to a control test session. Hypothalamic-pituitary-adrenal (HPA) responses were measured on salivary cortisol at about 20-minute intervals. Heart rate was measured continuously. Delta AUCs were computed for both heart rate (dAUCHR) and salivary cortisol (dAUCCORT), as a measure of response to the test.The public speaking task resulted in significant responses in heart rate and salivary cortisol in healthy control children, but not in MCDD children. dAUCHR was 3.28+/-2.37 in healthy control children, but -0.09+/-1.73 in MCDD children (t=3.31, P<0.01). dAUCCORT was 3.22+/-3.16 in healthy control children, but 0. 17+/-1.74 in MCDD children (t=2.72, P<0.05).The impaired responses to psychosocial stress found in MCDD children may be the result of their limited abilities to react adequately to their (social) environment. The same impairment in stress processing has been found in schizophrenia, and might be a factor in the vulnerability of these MCDD children to develop schizophrenia.

Cardiovascular and cortisol responses to a psychological stressor during pregnancy

Background. The goal of this study was to describe the physiological reactions of pregnant women confronted with an experimental psychosocial stressor, and to determine whether the protocol is adequate for stress testing during pregnancy. Methods. Healthy primiparae (n = 120) took part in a public speaking and mental arithmetic test. Results. The protocol was found to induce significant increases in saliva cortisol, systolic and diastolic blood pressure and heart rate. The physiological reactions were relatively large compared to those of earlier published studies using physical and psychological stressors during pregnancy, but comparable or slightly lower than those of a group of non‐pregnant participants (n = 31) tested with a similar protocol. Also, inter‐individual variability in reactivity was found, with subjects differing substantially in the magnitude of their reactions to the experimental situation. The cardiovascular responses were correlated to each other and to the overall level of cortisol during the test. Finally, reactivity showed circadian variations with cortisol and systolic blood pressure reactions significantly different (i.e. smaller or even absent) in subjects tested in the morning compared to those tested in the afternoon. Testing in the afternoon hours is recommended. Conclusions. The protocol described in this paper appears to constitute an adequate tool for studying differences in maternal stress reactivity during pregnancy, and as such, can be valuable for studies on maternal prenatal stress.

Longitudinal associations in adolescence between cortisol and persistent aggressive or rule-breaking behavior

Although several studies have associated antisocial behavior with decreased cortisol awakening responses (CAR), studies in adolescent samples yielded inconsistent results. In adolescence however, the CAR develops and antisocial behavior is heterogeneous in type and persistence. Therefore this longitudinal study compared persistent aggressive and rule-breaking adolescents to low aggressive and rule-breaking adolescents on the development of the CAR from ages 15 to 17 (N=390). Persistently high aggressive adolescents showed decreased cortisol levels at awakening consistently over the years (Δχ(2)(1)=6.655, p=.01) as compared to low aggressive adolescents. No differences between adolescents showing persistent high rule-breaking and low rule-breaking were found. This longitudinal study is the first to show that persistent aggression, but not rule-breaking behavior, is related to neurobiological alterations. Moreover, despite development of the CAR over adolescence, the decrease in cortisol is consistent over time in persistent high aggressive adolescents, which is an important prerequisite for the prediction of persistent aggression.

The predictive value of low heart rate and heart rate variability during stress for reoffending in delinquent male adolescents

Low autonomic (re)activity is a consistent correlate of antisocial behavior in juveniles. However, longitudinal research relating autonomic measures to persistent antisocial behavior has remained scarce. Therefore, in the present study we examined the predictive value of heart rate (HR) and heart rate variability (HRV, often studied as respiratory sinus arrhythmia) for reoffending in delinquent male adolescents. At initial assessment, HR and HRV were measured at rest and in response to a public speaking task. Registered reoffending was assessed after 5-year follow-up. Attenuated HR response and stronger HRV response to stress predicted higher reoffending rates. Results provide evidence that HR/HRV reactivity are neurobiological markers for persistent juvenile antisocial behavior. Although effect sizes were small to moderate, our findings underscore the consistency of the relationship between autonomic markers and antisocial behavior.

Offense related characteristics and psychosexual development of juvenile sex offenders.

Objective:This article reports on offense related characteristics and the psychosexual development in subgroups of juvenile sex offenders as measured by the Global Assessment Instrument for Juvenile Sex Offenders (GAIJSO). The predictive validity of these characteristics for persistent (sexual) offensive behavior in subgroups of juvenile sex offenders was investigated.Methods:One hundred seventy four sex offenders (mean age 14.9 SD 1.4) referred by the police to the Dutch Child Protection Board were examined. Offense related characteristics were assessed by means of the GAIJSO and the BARO (a global assessment tool for juvenile delinquents), and criminal careers of the subjects were ascertained from official judicial records.Results:Serious need for comprehensive diagnostics were found on the domains sexual offense and psychosexual development in juvenile sex offenders, especially in the group of child molesters. These youngsters displayed more internalizing and (psychosexual) developmental problems and their sexual offense was more alarming as compared to the other juvenile sex offender subgroups. Although one third of the juveniles had already committed one or more sex offenses prior to the index offense, at follow up (mean follow up period: 36 months SD 18 months) almost no sexual recidivism was found (0.6% of the entire sample). However, a substantial proportion of the entire sample of juvenile sex offenders showed non-sexual (55.6%) and violent recidivism (32.1%). Several predictors for a history of multiple sex offending and non-sexual recidivism were identified.Conclusion:This study revealed numerous problems in juvenile sex offenders. Assessment using the GAIJSO is helpful in order to identify indicators for extensive diagnostic assessment. In order to investigate the predictive validity for sexual reoffending a longer follow up period is necessary.

Long-term stability of the cortisol awakening response over adolescence

The cortisol awakening response (CAR) has been widely assessed as a measure of hypothalamic-pituitary-adrenal (HPA) axis activity. Short-term stability is high; however, little is known about the long-term stability of the CAR. Because there are indications that development in adolescence influences HPA axis activity, this study investigated the stability of the CAR over adolescence. Participants were 229 boys and 181 girls from an adolescent general population sample who were assessed in three consecutive years, at mean ages of 15.0 (SD=0.4), 16.0 (SD=0.4) and 17.0 (SD=0.4) years. Cortisol was analyzed in saliva sampled at awakening, and 30 and 60min later. Stability was investigated both as rank-order and as mean-level stability. Effects of physical development during adolescence on stability were investigated as well. Rank-order stability was moderate to low, with tracking coefficients (interpretable as stability coefficients over time) of .15 (p<.001) for cortisol at awakening and .24 (p<.001) for cortisol 30 and 60min after awakening. Mean-levels of cortisol at awakening did not change, while the response to awakening increased over the years (linear slopes for cortisol 30 and 60min after awakening all p<.01). The increase may reflect the physical development of the adolescents. This is the first study, in a large population based sample, indicating that the rank-order of the CAR is stable over the course of several years. Interestingly, mean-levels of the cortisol response to awakening increased over the years, suggesting a maturation of HPA axis reactivity in relation to physical development over adolescence. Physical development should therefore be taken into account when investigating the CAR as a measure of HPA axis activity in adolescence.

Instruments measuring externalizing mental health problems in immigrant ethnic minority youths: a systematic review of measurement properties.

Background Little is known about reliability and validity of instruments measuring externalizing mental health problems in immigrant ethnic minority youths. Aims To provide an overview of studies on measurement properties of instruments measuring these problems in immigrant ethnic minority youths, their methodological quality and results. Methods A systematic review of the literature in MEDLINE, EMbase, PsycINFO and Cochrane Library was performed. Evaluation of methodological quality of studies found was done by using the ‘COSMIN-checklist’. Full text, original articles, published in English after 1990 were included. Articles had to concern the development or evaluation of the measurement properties of self-reported, parent-reported and/or teacher- or clinician-reported questionnaires assessing or screening externalizing mental health problems in immigrant ethnic minority youths. Specific results of analyses on (an) immigrant ethnic minority group had to be given. Results Twenty-nine studies evaluating 18 instruments met our criteria. Most studies concerned instruments with known validity in Western populations, tested mainly in African Americans. Considering methodological quality, inequivalences between ethnicities were found, self-reports seemed to perform better, and administration of an instrument influenced reliability and validity. Conclusion It seems that the majority of instruments for assessing externalizing problems in immigrant ethnic minority youths is currently not sufficiently validated. Further evaluating existing instruments is crucial to accurately assess and interpreted externalizing problems in immigrant ethnic minority youths.

Autistic symptoms in childhood arrestees: longitudinal association with delinquent behavior

BACKGROUND To compare childhood arrestees with matched comparison groups on levels of autistic symptoms and to assess the unique predictive value of autistic symptoms for future delinquent behavior in childhood arrestees. METHODS Childhood first-time arrestees (n = 308, baseline age 10.7 ± 1.5 years) were followed up for 2 years. Autistic symptoms, externalizing disorders and delinquent behavior were assessed yearly. Childhood arrestees were compared on autistic symptoms with matched (age, gender) general population and clinical autism spectrum disorder samples. The predictive value of autistic symptoms for delinquent behavior was analyzed using generalized estimating equations. RESULTS At each assessment, levels of autistic symptoms in childhood arrestees were in between levels found in the general population and autism spectrum disorder samples. Autistic symptoms were positively associated with delinquent behavior in childhood arrestees, even after adjustment for externalizing disorders: IRR (incidence rate ratio) 1.23; 95% CI 1.11-1.36 and IRR 1.29; 95% CI 1.15-1.45 for core autistic symptoms and total symptom score, respectively. CONCLUSIONS Autistic symptoms are more prevalent in childhood arrestees compared to the general population and are uniquely associated with future delinquent behavior. Attention should, therefore, be given to the possible presence of autism related symptomatology in these children. Implications for diagnostic assessment and intervention need further investigation.