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Purpose Conduct problem behaviors are highly heterogeneous symptom clusters, creating many challenges in investigating etiology and planning treatment. The aim of this study was to first identify distinct subgroups of males and females with conduct problems using a data driven approach and, secondly, to investigate whether these subgroups differed in treatment outcome after an evidence-based crime prevention program. Methods We used a latent class analysis (LCA) in Mplus` to classify 517 males and 354 females (age 6–11) into classes based on the presence of conduct disorder or oppositional defiance disorder items from the Child Behavior Checklist. All children were then enlisted into the 13-week group core component (children and parent groups) of the program Stop Now And Plan (SNAP®), a cognitive-behavioral, trauma-informed, and gender-specific program that teaches children (and their caregivers) emotion-regulation, self-control, and problem-solving skills. Results The LCA revealed four classes for males, which separated into (1) “rule-breaking,” (2) “aggressive,” (3) “mild,” and (4) “severe” conduct problems. While all four groups showed a significant improvement following the SNAP program, they differed in the type and magnitude of their improvements. For females, we observed two classes of conduct problems that were largely distinguishable based on severity of conduct problems. Participants in both female groups significantly improved with treatment, but did not differ in the type or magnitude of improvement. Conclusion This study presents novel findings of sex differences in clustering of conduct problems and adds to the discussion of how to target treatment for individuals presenting with a variety of different problem behaviors.

Translational Psychiatry 11, 553 (2021). doi:10.1038/s41398-021-01643-w, Published by Nature Publishing Group, London

Background: Stop, Now And Plan (SNAP) is a cognitive behavioral-based psychosocial intervention that has a strong evidence base for treating youth with high aggression and externalizing behaviors, many of whom have disruptive behavior disorders. In a pre-post design, we tested whether SNAP could improve externalizing behaviors, assessed by the parent-rated Child Behavior Checklist (CBCL) and also improve behavioral measures of impulsivity in children with high aggression and impulsivity. We then investigated whether any improvement in externalizing behavior or impulsivity was associated with gray matter volume (GMV) changes assessed using structural magnetic resonance imaging (sMRI). We also recruited typically developing youth who were assessed twice without undergoing the SNAP intervention.Methods: Ten children who were participating in SNAP treatment completed the entire study protocol. CBCL measures, behavioral measures of impulsivity, and sMRI scanning was conducted pre-SNAP and then 13 weeks later post-SNAP. Twelve healthy controls also completed the study; they were rated on the CBCL, performed the same behavioral measure of impulsivity, and underwent sMRI twice, separated by 13 weeks. They did not receive the SNAP intervention.Result: At baseline, SNAP participants had higher CBCL scores and performed worse on the impulsivity task compared with the healthy controls. At the second visit, SNAP participants still had higher scores on the CBCL compared with normally-developing controls, but their performance on the impulsivity task had improved to the point where their results were indistinguishable from the healthy controls. Structural magnetic resonance imaging in the SNAP participants further revealed that improvements in impulsivity were associated with GMV changes in the frontotemporal region.Conclusion: These results suggest that SNAP led to improvement in behavioral measures of impulsivity in a cohort of boys with high externalizing behavior. Improvement in impulsivity was also associated with increased GMV changes. The mechanism behind these brain changes is unknown but could relate to cognitive behavioral therapy and contingency management interventions, important components of SNAP, that target frontotemporal brain regions. Clinically, this study offers new evidence for the potential targeting of brain regions by non-invasive modalities, such as repetitive transcranial magnetic stimulation, to improve externalizing behavior and impulsivity.

As the main excitatory neurotransmitter in the central nervous system, glutamate, as measured in combination with glutamine (Glx), is implicated in several psychopathologies when levels are aberrant. One illness that shows heightened Glx levels is bipolar disorder (BD), an illness characterized by high impulsivity. In addition, although animal studies have reported elevated levels of Glx in aggressive and impulsive phenotypes, no study, to our knowledge, has reported Glx in the human cortex in relation to aggression. Here, we addressed the question of whether elevated levels of Glx would be present in patients with BD and antisocial personality disorder (ASPD), a condition associated with aggression and, like BD, also presents high impulsivity. We recruited individuals with ASPD (n = 18), individuals with BD (n = 16), and a healthy control group (n = 24). We used proton magnetic resonance spectroscopy to measure relative neurometabolite concentrations in the left dorsolateral prefrontal cortex (dlPFC) and supra-genual anterior cingulate cortex (ACC), two brain regions associated with impulsivity and behavior control. We found significantly elevated levels of Glx in the ASPD group relative to the BD and healthy control groups in the dlPFC (p = .014), and a positive correlation between Glx levels and aggression in the dlPFC in the ASPD group alone (r = .59, p = .026). These findings suggest a link between aggression in ASPD and Glx levels.

The ability to identify early risk factors for antisocial behavior in children is one of the most important and difficult challenges in the fields of developmental criminology and mental health. It is also a necessary first step in assigning suitable interventions to minimize risk for these children. The Early Risk Assessment List (EARL) was the first gender specific psychosocial assessment framework for identifying and monitoring risk and need for children with antisocial behavior under age 12. Since the first iteration in 1998, a broad range of scientific studies have been conducted on the validity and applicability of the EARL across settings and cultures. This chapter provides readers with a history of the EARL, the structure and content of the assessment, a review of its reliability and validity, and how the tool may be used to inform risk management plans to reduce disruptive behavior and the risk of criminal involvement in young children. A case example is provided.

This chapter reviews the neuroscience of antisocial and offending behavior in child and adolescent populations. It explores the role of neurobiological factors in driving the age-crime curve in offending behavior and the neurobiological bases of sex differences in aggression and antisocial behavior. The chapter discusses what neurobiological and neuroimaging evidence has to say about the validity and utility of different subtyping approaches such as those based on age-of-onset of antisocial behavior or the presence or absence of callous-unemotional personality traits. It expresses that some subtyping approaches, such as those based on assessing callous-unemotional traits, have been tested quite extensively using neurobiological or neuroimaging methods, whereas others, such as the behavioral subtype approach have received relatively little attention in the neuroimaging literature. The chapter considers potential of neuroscience methods to contribute to clinical practice in forensic psychology and psychiatry, evaluation of treatment or rehabilitation approaches, and the prediction of future risk for violence or criminal behavior.

© 2017, The Author(s). Altered decision making processes and excessive risk-seeking behaviours are key features of conduct disorder (CD). Previous studies have provided compelling evidence of abnormally increased preference for risky options, higher sensitivity to rewards, as well as blunted responsiveness to aversive outcomes in adolescents with CD. However, most studies published to date have focused on males only; thus, it is not known whether females with CD show similar alterations in decision making. The current study investigated potential sex differences in decision making and risk-seeking behaviours in adolescents with CD. Forty-nine adolescents with CD (23 females) and 51 control subjects (27 females), aged 11-18 years, performed a computerised task assessing decision making under risk—the Risky Choice Task. Participants made a series of decisions between two gamble options that varied in terms of their expected values and probability of gains and losses. This enabled the participants’ risk preferences to be determined. Taking the sample as a whole, adolescents with CD exhibited increased risk-seeking behaviours compared to healthy controls. However, we found a trend towards a sex-by-group interaction, suggesting that these effects may vary by sex. Follow-up analyses showed that males with CD made significantly more risky choices than their typically developing counterparts, while females with CD did not differ from typically developing females in their risk-seeking behaviours. Our results provide preliminary evidence that sex may moderate the relationship between CD and alterations in risk attitudes and reward processing, indicating that there may be sex differences in the developmental pathways and neuropsychological deficits that lead to CD. European Commission’s Seventh Framework Programme for research, technological development and demonstration (FP7/2007-2013) under Grant Agreement no. 602407 (FemNAT-CD).

Journal of the American Academy of Child and Adolescent Psychiatry : JAACAP 58(12), 1184-1196 (2019). doi:10.1016/j.jaac.2019.02.019, Published by Elsevier, Kidlington [u.a.]

Human communication relies on the ability to process linguistic structure and to map words and utterances onto our environment. Furthermore, as what we communicate is often not directly encoded in our language (e.g. in the case of irony, jokes or indirect requests), we need to extract additional cues to infer the beliefs and desires of our conversational partners. Although the functional interplay between language and the ability to mentalise has been discussed in theoretical accounts in the past, the neurobiological underpinnings of these dynamics are currently not well understood. Here, we address this issue using functional imaging (fMRI). Participants listened to question-reply dialogues. In these dialogues, a reply is interpreted as a direct reply, an indirect reply or a request for action, depending on the question. We show that inferring meaning from indirect replies engages parts of the mentalising network (mPFC) while requests for action also activate the cortical motor system (IPL). Subsequent connectivity analysis using Dynamic Causal Modelling (DCM) revealed that this pattern of activation is best explained by an increase in effective connectivity from the mentalising network (mPFC) to the action system (IPL). These results are an important step towards a more integrative understanding of the neurobiological basis of indirect speech processing.

The aim of this article is to review findings from the neurobiological, neuroimaging, and neuropsychological literature that have contributed to our understanding of the etiology and development of disruptive behavior disorders, with particular reference to conduct disorder. This review focuses on neurobiological systems such as the hypothalamic–pituitary–adrenal axis and neuroimaging evidence linking disruptive behavior disorders to changes in brain functioning or structure. Overall, this research suggests that brain areas involved in emotional processing and regulation are particularly compromised in children and adolescents with disruptive behavior disorder, which fits with evidence obtained from neuropsychological studies. This review highlights the importance of neuroscientific research in characterizing reliable brain-based functional and structural biomarkers that may contribute to an increased understanding of, and the development of new treatments for, antisocial and aggressive behavior in children and adolescents.

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.