Marlene M. Moretti

Aggressive and Antisocial Girls: Research Update and Challenges

There is a growing recognition that a significant number of young women engage in highly aggressive and antisocial behaviors. This acknowledgement has created demands on both policy and program development. The response to these demands, however, has been delayed due to the fact that we still know relatively little about aggressive and antisocial behavior in girls. In this article, we briefly review trends in the rates of aggressive and antisocial acts among female youth, address the issue of gender specific forms of aggression, and discuss research on the role of risk and protective factors. We emphasize the importance of understanding female aggression and antisocial behavior through a dynamic developmental framework that recognizes the cumulative and transactional impact of risk and protective factors over time. Our review focuses on adolescent girls in keeping with research that suggests that the risk for aggressive and antisocial behavior in girls is most acute during this developmental period.

Examining the science and practice of violence risk assessment with female adolescents

While the field of violence risk assessment among adult males has progressed rapidly, several questions remain with respect to the application of forensic risk assessment tools within other populations. In this article, we consider the empirical evidence for the assessment, prediction, and management of violence in adolescent girls. We discuss limitations of generalizing violence risk assessment findings from other populations to adolescent girls and point out areas where there is little or no empirical foundation. Critical issues that must be addressed in research prior to the adoption or rejection of such instruments are delineated. Finally, we provide practice guidelines for clinicians currently involved with adolescent females within risk assessment contexts.

Suicidal ideation in an adolescent clinical sample: attachment patterns and clinical implications

This study investigated the relationship between attachment patterns and suicidal ideation in a clinical sample of adolescents. Participants (n = 116) were assessed on level of current ideation through self-report questionnaires. Lethality of methods contemplated was also rated on a subset of the sample (n = 16) who, in addition to endorsing current suicidal ideation, presented a plan on a diagnostic interview. Quality of attachment to care-givers based on a semi-structured clinical interview was assessed using Bartholomews two-dimensional, four-category model of attachment. Categorical analyses indicated that youth with predominantly fearful or preoccupied attachment were more likely to endorse suicidal ideation than were predominantly secure or dismissing youth. Severity of suicidal ideation was positively correlated with ratings of fearfulness and negatively correlated with ratings on the secure and dismissing patterns. Greater lethality in methods of contemplated suicide was positively correlated with preoccupied tendencies. The importance of attachment theory for understanding the factors underlying suicidal ideation in troubled youth is discussed and implications for therapeutic intervention are presented.

Rumination on Anger and Sadness in Adolescence: Fueling of Fury and Deepening of Despair

We examined anger rumination and sadness rumination in clinic-referred adolescents (N = 121). Factor analysis indicated that items from analogous anger and sadness rumination measures loaded onto 2 factors tapping anger rumination and sadness rumination, respectively. Structural equation modeling confirmed unique relations between each form of rumination and specific emotional or behavioral problems. Anger and anger rumination were independent predictors of aggression, suggesting that both the affective component of anger (i.e., angry feelings) and the cognitive process (i.e., recurrent thoughts about anger) are important in predicting aggressive behavior. Girls reported higher levels of both forms of rumination compared to boys; however, no sex differences were found in the relations between either form of rumination and outcomes.

Gender differences in risk factors for violence: an examination of the predictive validity of the Structured Assessment of Violence Risk in Youth

The research literature on predicting violence is particularly lacking in specifying risk factors for violence in adolescent girls. The recently developed Structured Assessment of Violence Risk in Youth [SAVRY; Borum et al., 2006] shows promise as it is empirically derived and incorporates dynamic factors in its assessment of risk. To date, there exists little information attesting to the reliability and validity of the SAVRY, and few investigations of the SAVRYs utility across gender. This study investigated the SAVRY in a sample of 144 high-risk adolescents (80 males and 64 females), focusing on gender discrepancies in the predictive utility of the measure. Results indicate that the SAVRY moderately predicts violent and non-violent reoffending in the entire sample, and also suggest that the SAVRY operates comparably across gender. Although not precluding the existence of gender-specific domains of risk, current results suggest that validated risk factors in boys hold relevance for the prediction of violence and delinquency in girls.

Conduct disorder and substance use disorder : comorbidity in a clinical sample of preadolescents and adolescents

Objective To examine the rate of comorbidity between conduct disorder and substance use disorder in a clinical sample using the Diagnostic Interview for Children and Adolescents - Revised. Method Examined the pattern of conduct disorder symptoms, including type, number, and severity, in conduct-disordered youth diagnosed with, and without a comorbid substance use disorder. Results The examination revealed no significant differences in the incidence of comorbidity between younger (aged 10 to 13) and older (above age 13) youth. Among youth who met criteria for conduct disorder, 52% also met criteria for a substance use disorder. Odds ratios indicated that the probability of comorbidity of conduct and substance use disorders was higher in the younger group. Conclusion Substance abuse and dependence tend to develop rapidly following first use, suggesting that a slim window of opportunity exists to prevent substance disorders once drug use has begun.

Symptoms of posttraumatic stress disorder in adolescents with conduct disorder: Sex differences and onset Patterns

Objective: To examine sex differences in the rate and symptoms of posttraumatic stress disorder (PTSD), trauma exposure, and onset patterns in youth with conduct disorder (CD). Method Youth admitted to a clinical facility for severe behaviour problems completed the Diagnostic Interview for Children and Adolescents – Revised (DICA-R) to assess the presence of CD and PTSD. Results Over one-half of CD youth reported exposure to trauma, yet only 17% met criteria for PTSD. PTSD was more frequent in CD girls (28%) than in boys (10%), and girls experienced greater symptom intensity and anhedonia, difficulty feeling love or affection, and disturbance of sleep and concentration. Girls more frequently reported sexual assault, while boys were more likely to report accidents, physical assaults, and witnessing the death of a loved one. Retrospective reports indicated that PTSD tended to develop subsequent to CD. Conclusions Exposure to trauma is common among CD youth; however, diagnostic procedures should be adapted for increased sensitivity to PTSD. The development of CD may increase the risk for PTSD, particularly in girls, by exposing youth to situations in which they are traumatized. The role of trauma in CD should be routinely examined by clinicians and warrants further research.

The dynamics of measuring attachment.

Shaver and Mikulincer’s review makes a strong case that self-reports of adult attachment are associated with attachment-related processes that are unconscious or at least that occur automatically and outside of awareness. Therefore, the common criticism that self-reports cannot meaningfully assess attachment orientations in a manner that is ree ective of dynamic processes is clearly false. The belief that interview measures are the only valid way to assess adult attachment is based in fundamental assumptions about what can and cannot be assessed in self-reports, and what needs to be assessed in determining adult attachment orientation. The AAI approach to assessing adult attachment is based on the assumption that assessment of defensive strategies, which operate at least partially outside of conscious awareness, is a necessary component in the evaluation of ‘states of mind’ with respect to attachment. Moreover, it is assumed that these strategies can be accurately scored (given appropriate training of coders) from the transcripts of interviews in which participants discuss the relationships they had with their parents in childhood. The attachment strategies identie ed in the AAI are assumed to ree ect processes that operate outside the interview setting, especially in attachment-relevant contexts such as parenting. By dee nition, individuals with particular attachment strategies deny some types of psychological experiences and/or distort their responses to questions tapping these experiences. AAI advocates would therefore tend to conclude that it makes little sense to ask individuals with insecure attachment patterns direct questions about processes that are assumed to be defensively distorted and not open to conscious access. In contrast, they would argue that interview procedures are the most appropriate way to assess adult attachment because defensive strategies can be assessed and provide important clues to underlying attachment issues. Thus, it is common in the attachment literature to see comments such as: ‘Because we are interested in differences in processing attachment-related thoughts and feelings, we deal only with e ndings linking attachment states of mind [as assessed by the AAI] with psychopathology’ (Dozier, Stovall, & Albus, 1999, p. 498). How can self-reports be useful if this is true? One possibility is that self-reports about attachment are valid assessments of dynamic processes. This seems unlikely since these reports are not designed to assess such processes. Another possibility, suggested by Hesse (1999), is that states of mind with respect to early attachment experiences are not necessarily available to conscious awareness (therefore requiring interview measures to assess), but attachment orientations in the romantic domain are (therefore allowing for self-report assessments). However, we cannot think of any good reasons why the process of recalling and reporting on childhood experiences would be qualitatively different from the process of recalling and reporting on

Self-discrepancies and negative affect: A primer on when to look for specificity, and how to find it

There is substantial evidence that discrepancies within the self-system produce emotional distress. However, whether specific types of discrepancy are related to different types of negative affect remains contentious. At the heart of self-discrepancy theory (SDT: Higgins, 1987, 1989) is the assumption that different types of discrepancies are related to distinctive emotional states, with discrepancies between the actual and ideal selves being uniquely related to dejection-related emotion and discrepancies between the actual and ought selves being uniquely related to agitation-related emotion. Research examining this proposition has demonstrated that the magnitudes of these discrepancies are substantially correlated. As a result, some researchers have questioned whether they are functionally independent (e.g., Tangney, Niedenthal, Covert, & Barlow, 1998). In addition, other researchers have failed to support the hypothesized unique relationships (e.g., Ozgul, Heubeck, Ward, & Wilkinson, 2003). Together these two types of research finding have been interpreted as presenting a challenge to SDT. It is our contention that this interpretation is inaccurate. In this paper, we review the assumptions made when testing for these distinct relationships. Specifically, we examine the necessary conditions under which the functional independence of discrepancies is apparent, and the statistical methods appropriate to test these relationships. We also comment on the measurement of self-discrepancies, and fundamental problems in the interpretation of null findings. We conclude that studies using appropriate methodological and statistical procedures have produced ample evidence that discriminant relationships exist, and we encourage researchers to further investigate the conditions under which these relationships are most apparent.

Long term outcome of an attachment-based program for conduct disorder

There is increasing concern among professionals and the public about the level of violence and antisocial behaviour among our youth. This has been coupled with confusion and a sense of helplessness about which types of interventions are most effective in responding to these difficulties. Some professionals and advocacy groups are calling for tougher disciplinary responses to violence and antisocial behaviour, including changes in the Young Offenders Act Yet, such interventions are rarely effective in producing the desired reductions in these behaviours. Other professionals have called for better forms of treatment. However, few treatments have been shown to be effective in bringing about long term reductions either in aggressive behaviour or in the concomitant psychological difficulties experienced by these youths. In this paper, a description is presented of an approach to understanding conduct disorder that focuses on attachment as an organizing principle of behaviour and affect. Also, a description is presented of a community-oriented program that is based on attachment theory, as well as the results of the program evaluation at six, 12 and 18 months following discharge. The findings replicate and extend earlier findings reported by Holland et al (1) on the effectiveness of this approach.