Theo A. H. Doreleijers

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.

Young Adult Psychological Outcome After Puberty Suppression and Gender Reassignment

BACKGROUND: In recent years, puberty suppression by means of gonadotropin-releasing hormone analogs has become accepted in clinical management of adolescents who have gender dysphoria (GD). The current study is the first longer-term longitudinal evaluation of the effectiveness of this approach. METHODS: A total of 55 young transgender adults (22 transwomen and 33 transmen) who had received puberty suppression during adolescence were assessed 3 times: before the start of puberty suppression (mean age, 13.6 years), when cross-sex hormones were introduced (mean age, 16.7 years), and at least 1 year after gender reassignment surgery (mean age, 20.7 years). Psychological functioning (GD, body image, global functioning, depression, anxiety, emotional and behavioral problems) and objective (social and educational/professional functioning) and subjective (quality of life, satisfaction with life and happiness) well-being were investigated. RESULTS: After gender reassignment, in young adulthood, the GD was alleviated and psychological functioning had steadily improved. Well-being was similar to or better than same-age young adults from the general population. Improvements in psychological functioning were positively correlated with postsurgical subjective well-being. CONCLUSIONS: A clinical protocol of a multidisciplinary team with mental health professionals, physicians, and surgeons, including puberty suppression, followed by cross-sex hormones and gender reassignment surgery, provides gender dysphoric youth who seek gender reassignment from early puberty on, the opportunity to develop into well-functioning young adults.

Puberty Suppression in Adolescents With Gender Identity Disorder: A Prospective Follow‐Up Study

INTRODUCTION Puberty suppression by means of gonadotropin-releasing hormone analogues (GnRHa) is used for young transsexuals between 12 and 16 years of age. The purpose of this intervention is to relieve the suffering caused by the development of secondary sex characteristics and to provide time to make a balanced decision regarding actual gender reassignment. AIM To compare psychological functioning and gender dysphoria before and after puberty suppression in gender dysphoric adolescents. METHODS Of the first 70 eligible candidates who received puberty suppression between 2000 and 2008, psychological functioning and gender dysphoria were assessed twice: at T0, when attending the gender identity clinic, before the start of GnRHa; and at T1, shortly before the start of cross-sex hormone treatment. MAIN OUTCOME MEASURES Behavioral and emotional problems (Child Behavior Checklist and the Youth-Self Report), depressive symptoms (Beck Depression Inventory), anxiety and anger (the Spielberger Trait Anxiety and Anger Scales), general functioning (the clinicians rated Childrens Global Assessment Scale), gender dysphoria (the Utrecht Gender Dysphoria Scale), and body satisfaction (the Body Image Scale) were assessed. RESULTS Behavioral and emotional problems and depressive symptoms decreased, while general functioning improved significantly during puberty suppression. Feelings of anxiety and anger did not change between T0 and T1. While changes over time were equal for both sexes, compared with natal males, natal females were older when they started puberty suppression and showed more problem behavior at both T0 and T1. Gender dysphoria and body satisfaction did not change between T0 and T1. No adolescent withdrew from puberty suppression, and all started cross-sex hormone treatment, the first step of actual gender reassignment. CONCLUSION Puberty suppression may be considered a valuable contribution in the clinical management of gender dysphoria in adolescents.

The Impact of Protective Factors in Desistance From Violent Reoffending: A Study in Three Samples of Adolescent Offenders

This study examined the impact of protective factors, assessed by means of the Structured Assessment of Violence Risk in Youth (SAVRY), on desistance from violent reoffending in adolescents. Three samples included male adolescents in different stages of the judicial process: pre-trial (n = 111); during residential treatment (n = 66); and after release from a juvenile justice facility ( n = 47). The results lend support to the hypothesis that protective factors buffer or mitigate the risk of violent reoffending. Using regression analyses, in all samples, the addition of protective factors yielded a significant increment in the amount of variance explained by dynamic risk factors alone. Furthermore, in medium to high risk subgroups, the violent reoffending rate was significantly higher when protective factors were absent, compared to when protective factors were present. These findings are discussed in terms of their implications for risk assessment and risk management practice with adolescent offenders.

Predictive validity of the Structured Assessment of Violence Risk in Youth (SAVRY) during residential treatment

This prospective study examines the predictive validity of the Dutch version of the Structured Assessment of Violence Risk in Youth (SAVRY) by examining relationships between SAVRY scores and various types of disruptive behavior during residential treatment. The SAVRY, a risk assessment instrument, was coded for 66 male adolescents on the basis of file information and interviews. The adolescents were referred to Rentray, a juvenile correctional and treatment facility, by the Dutch juvenile courts because of severe behavioral problems or serious offenses. Institutional infractions were retrieved from incident registration files, which included acts of physical violence, verbal threat, verbal abuse, and violation of institutional rules. The interrater reliability of the SAVRY scores was good. The predictive validity of the SAVRY for physical violence against persons was excellent (Risk Total: AUC=.80, r =.33; Summery Risk Rating: AUC =.86, r =.48). The SAVRY also had good predictive validity for violence against objects, verbal threats and violations of rules, but not for verbal abuse. Implications for assessment and management of violent behavior among adolescents in residential treatment are discussed.

Juvenile Sex Offenders Compared to Non-Sex Offenders: A Review of the Literature 1995-2005

An unresolved but clinically important issue in the literature on juvenile delinquency is to what extent juvenile sex offenders resemble non-sex offenders with respect to individual, familial, and environmental characteristics. The current article reviewed published studies (1995-2005) comparing sex offenders with non-sex offenders. The 17 articles meeting the inclusion criteria suggest that differences exist between sex offenders and non-sex offenders on personality characteristics, behavioral problems, history of sexual abuse, nonsexual offending, and peer functioning. Inconsistent results were found for demographic factors, family functioning and background, antisocial attitudes, and intellectual and neurological functioning. Although it is likely that sex offenders can be differentiated from nonsex offenders on a number of characteristics, caution is warranted because of methodological differences between studies and small samples size. Also, studies show that sex offenders are a heterogeneous group. Further research should take into account this heterogeneity by including sex offenders from clearly circumscribed groups and investigating characteristics specifically related to sexual behavior.

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.

Gross motor performance and self-perceived motor competence in children with emotional, behavioural, and pervasive developmental disorders: a review

Aims Motor performance and self‐perceived motor competence have a great impact on the psychosocial development of children in general. In this review, empirical studies of gross motor performance and self‐perception of motor competence in children with emotional (depression and anxiety), behavioural, and pervasive developmental disorders are scrutinized, with the objective of identifying specific motor characteristics that may be relevant to clinical practice.

The Diurnal Cortisol Cycle in Delinquent Male Adolescents and Normal Controls

Patterns of low hypothalamus–pituitary–adrenal (HPA) activity have been observed in antisocial groups. As conflicting results have been reported in children and adolescents, the aim of this study was to further investigate HPA activity in antisocial behavior by studying the relationship between the diurnal cortisol cycle, as well as the cortisol awakening response (CAR), and antisocial behavior in male adolescents. The diurnal cortisol cycle and the CAR during the first hour after awakening were compared between 12- to 14-year-old boys who attended a delinquency diversion program (DP), with and without a disruptive behavior disorder (DBD) (respectively DP+; n=24 and DP−; n=65), and matched normal controls (NC; n=32). The DP+ group, but not the DP− group, showed a significantly slower decrease of cortisol during the diurnal cycle than the NC group. Furthermore, the DP+ group had significantly lower cortisol levels in the first hour after awakening as compared with the NC group. The results indicate altered HPA activity in delinquent boys with a DBD. Etiological mechanisms, directions for future research, and clinical implications are discussed.

Juvenile Sex Offenders: A Group on its Own?

There is some debate about whether sex offenders are similar to non-sex offenders. It is known that sex and non-sex offenders are heterogeneous groups. Comparative studies must take this heterogeneity into account. Based on an aggregated database, a study was conducted among adjudicated juvenile (sex) offenders. The sample consisted of juvenile male sex and non-sex offenders who had been subjected to a psychological assessment at the request of the judge or district attorney. The central question focused on the differences between juvenile sex offenders, in particular rapists and sexual assaulters (n = 57), child molesters (n= 55), and non-sex offenders: violent (n = 85) and nonviolent offenders (n = 80). The results demonstrated that sex offenders differ from non-sex offenders with regard to demographic characteristics, problem behavior, and personality traits. Some reference is made regarding future research.