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As most research on conduct disorder (CD) has been conducted on male participants, it has been suggested that female-specific symptoms may be underestimated based on current DSM-5 criteria. In particular, relational aggression, i.e. the hurtful, often indirect, manipulation of relationships with the intention of damaging the other's social position, has been proposed as a characteristic of CD that is more common in females. In addition, sex-specific studies on correlates of relational aggressive behavior are lacking. Relational aggression may be strongly related to the correlates of proactive aggression, namely low affective empathy, and high levels of callous-unemotional (CU) traits and relational victimization. Thus, the present study investigated sex differences in relational aggression, and associations between relational aggression and correlates of proactive aggression in 662 adolescents with CD (403 females) and 849 typically-developing controls (568 females) aged 9-18 years (M = 14.74, SD = 2.34) from the European multi-site FemNAT-CD study. Females with CD showed significantly higher levels of relational aggression compared to males with CD, whereas no sex differences were seen in controls. Relational aggression was only partly related to correlates of proactive aggression in CD: Independent of sex, CU traits showed a positive association with relational aggression. In females only, cognitive, but not affective empathy, was negatively associated with relational aggression. Relational victimization was more strongly associated with relational aggression in males compared to females. Despite interesting sex specific correlates of relational aggression, effects are small and the potential clinical implications should be investigated in future studies.

Disruptive behaviour disorders comprise the diagnosis conduct disorder (CD) and in adults the diagnosis antisocial personality disorder (APD). CD is seen as a difficult-to-treat disorder with a high risk for persistent behavioral problems. In addition, CD is seen as the precursor to antisocial personality disorder (Kretschmer et al., 2014). Dialectical behavior therapy (DBT) was originally developed by Marsha Linehan (1991) for the treatment of borderline personality disorder, but because of the core deficits in emotion regulation in disruptive behavior disorders, DBT is also increasingly being recommended for the treatment of CD and APD. This review presents DBT adaptions for the forensic setting and for the treatment of CD/APD. Clinical implications are discussed.

Recent neuroimaging work has suggested that aggressive behaviour (AB) is associated with structural and functional brain abnormalities in processes subserving emotion processing and regulation. However, most neuroimaging studies on AB to date only contain relatively small sample sizes. To objectively investigate the consistency of previous structural and functional research in adolescent AB, we performed a systematic literature review and two coordinate-based activation likelihood estimation meta-analyses on eight VBM and nine functional neuroimaging studies in a total of 783 participants (408 [224AB/184 controls] and 375 [215 AB/160 controls] for structural and functional analysis respectively). We found 19 structural and eight functional foci of significant alterations in adolescents with AB, mainly located within the emotion processing and regulation network (including orbitofrontal, dorsomedial prefrontal and limbic cortex). A subsequent conjunction analysis revealed that functional and structural alterations co-localize in right dorsomedial prefrontal cortex and left insula. Our results are in line with meta-analytic work as well as structural, functional and connectivity findings to date, all of which make a strong point for the involvement of a network of brain areas responsible for emotion processing and regulation, which is disrupted in AB. Increased knowledge about the behavioural and neuronal underpinnings of AB is crucial for the development of novel and implementation of existing treatment strategies. Longitudinal research studies will have to show whether the observed alterations are a result or primary cause of the phenotypic characteristics in AB.

Aggressive behavior has been linked to deficient processing of emotional stimulation and recent studies indicate that in aggressive juveniles executive functions are impaired when distressing emotional stimulation is being processed. This study examines the interrelation of distressing emotional stimulation and cognitive control in aggressive adolescents and healthy controls. We combined a color-word Stroop test with pictures from the International Affective Picture System with either neutral or distressing emotional content to assess Stroop interference under neutral and distressing emotional stimulation in 20 male reactive aggressive patients with conduct disorder (CD) and 20 age-matched male control participants. We found impaired Stroop performance under distressing emotional stimulation in patients compared to healthy controls. No difference was present under neutral emotional stimulation. Our results indicate that cognitive control under distressing emotional stimulation was affected in adolescents with CD but not in healthy controls. We conclude that executive functions in reactive aggressive CD patients are more susceptible to the deleterious effects of distressing emotional stimulation. The results provide a possible explanation for pathologic impulsive-aggressive behavior under emotional distress in CD patients., (© 2013 Wiley Periodicals, Inc.)

Objective: The risk for conduct disorder (CD) is markedly increased in children with specific temperament dimensions. Here, we investigated whether adverse temperament factors might contribute to an impairment in neural mechanisms underlying the regulation of aggressive behaviour., Method: Functional magnetic resonance imaging was performed in 13 male adolescents with CD aged 9 to 14 years and in 14 healthy age and sex-matched control subjects at 1.5T. During scanning, subjects looked at pictures from the International Affective Picture System with neutral or strong negative emotional valence. Temperament was assessed using the German version of the Junior Temperament and Character Inventory. In addition, behavioural control strategies (Wisconsin Card Sorting, Four Pack Card Playing Task) and sociomoral reasoning (Sociomoral Reflection Measure Short Form) were tested to behaviourally characterise the study groups., Results: When comparing CD patients with healthy controls, we found reduced activation in the right anterior cingulate cortex (ACC) in response to negative affective pictures. The temperament dimension 'novelty seeking' was a significant predictor for ACC responsiveness to affective pictures as revealed by a stepwise multiple regression analysis (beta=-0.53, p<0.01). Moreover, individuals with high 'novelty seeking' scores chose more disadvantageous strategies in the Four Pack Card Playing Task (p<0.05) and were characterised by a lower level of sociomoral reasoning (p<0.05)., Conclusion: The results of this study provide a link between temperament factors and neural correlates of emotion processing in adolesecents with conduct disorder.

Background: Conduct disorder (CD) and oppositional defiant disorder (ODD) both convey a high risk for maladjustment later in life and are understudied in girls. Here, we aimed at confirming the efficacy of START NOW, a cognitive‐behavioral, dialectical behavior therapy‐oriented skills training program aiming to enhance emotion regulation skills, interpersonal and psychosocial adjustment, adapted for female adolescents with CD or ODD. Methods: A total of 127 girls were included in this prospective, cluster randomized, multi‐center, parallel group, quasi‐randomized, controlled phase III trial, which tested the efficacy of START NOW (n = 72) compared with standard care (treatment as usual, TAU, n = 55). All female adolescents had a clinical diagnosis of CD or ODD, were 15.6 (±1.5) years on average (range: 12–20 years), and were institutionalized in youth welfare institutions. The two primary endpoints were the change in number of CD/ODD symptoms between (1) baseline (T1) and post‐treatment (T3), and (2) between T1 and 12‐week follow‐up (T4). Results: Both treatment groups showed reduced CD/ODD symptoms at T3 compared with T1 (95% CI: START NOW = −4.87, −2.49; TAU = −4.94, −2.30). There was no significant mean difference in CD/ODD symptom reduction from T1 to T3 between START NOW and TAU (−0.056; 95% CI = −1.860, 1.749; Hedge's g = −0.011). However, the START NOW group showed greater mean symptom reduction from T1 to T4 (−2.326; 95% CI = −4.274, −0.378; Hedge's g = −0.563). Additionally, secondary endpoint results revealed a reduction in staff reported aggression and parent‐reported irritability at post assessment. Conclusions: Although START NOW did not result in greater symptom reduction from baseline to post‐treatment compared with TAU, the START NOW group showed greater symptom reduction from baseline to follow‐up with a medium effect size, which indicates a clinically meaningful delayed treatment effect. [ABSTRACT FROM AUTHOR]

Background: Aggression comprises a heterogeneous set of behavioral patterns that aim to harm and hurt others. Empathy represents a potential mechanism that inhibits aggressive conduct and enhances prosocial behavior. Nevertheless, research results on the relationship between empathy and aggression are mixed. Subtypes of aggressive behavior, such as reactive and proactive aggression might be differently related to empathy. The aim of the present study was to investigate the interrelations of cognitive and affective empathy with reactive and proactive aggression. Methods: We recruited a sample of 177 (33% female, M age 15.6) adolescents from socio-educational and juvenile justice institutions and a community sample of 77 (36% female, M age 13.1) adolescents from secondary schools. Using bivariate correlation analysis and hierarchical multiple regression analysis, we firstly investigated associations between cognitive and affective empathy and reactive and proactive aggression. Subsequently, we performed cluster analysis to identify clusters of adolescents with meaningful profiles of aggressive behavior and compared derived clusters on measures of empathy. We applied the Basic Empathy Scale and the Reactive-Proactive Aggression Questionnaire. Results: Bivariate analysis and hierarchical regression analysis showed that cognitive and affective empathy were negatively associated with proactive aggression, but not with reactive aggression. Cluster-analysis revealed three clusters of adolescents with distinct aggression profiles: a cluster with elevated scores on reactive and proactive aggression, a clusters with high scores on reactive aggression only, and a low aggression cluster. Cluster comparisons revealed that the reactive-proactive aggression cluster showed significantly lower scores on cognitive and affective empathy than both other clusters. Results further indicated that within the reactive-proactive aggression cluster, girls did not differ significantly from boys in empathy. Conclusions: The present study extends previously published findings, and possibly explains conflicting results in prior research. Our results indicated that cognitive and affective empathy are reduced in adolescents with high levels of reactive and proactive aggression. Our study may contribute to the development of tailored clinical interventions for different aggression clusters. [ABSTRACT FROM AUTHOR]

Objective The present study investigated the effects of rapid tryptophan depletion (RTD) and the ensuing reduction of central nervous levels of serotonin (5-HT) on reactive aggression with respect to personality factors comprising aspects of trait-impulsivity and -aggression in boys with attention-deficit/hyperactivity-disorder (ADHD). Methods Twenty-two male adolescent patients with ADHD received the RTD test on one day, and, on another day a tryptophan balanced placebo in a double-blind within-subject crossover design. Impulsive personality factors and trait-impulsivity were assessed in advance of the study. Aggression was provoked using a competitive reaction time game 270 min after RTD/placebo intake. Results RTD had a significant effect on increased aggressive behaviour with which low-grade impulsive patients responded. High-grade impulsive patients were not affected by RTD or even responded with increased aggressive behaviour while receiving placebo treatment. Conclusions The present study supports the hypothesis that 5-HT functioning in ADHD patients influences reactive aggression depending on aspects of trait-impulsivity. Future studies are necessary in order to detect the specific influence of ADHD as regards the relevance to 5-HT-induced changed aggressive responding. Copyright © 2007 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Abstract: The goal of this study was to determine whether brain regions implicated in emotion processing show structural alterations in adolescents with conduct disorder (CD). Using an optimized voxel-based morphometry protocol, we compared grey matter volume in 12 patients with CD and 12 age-, sex-, and intelligence-matched control subjects. Grey matter volume in bilateral anterior insular cortex and the left amygdala was significantly reduced in CD patients compared to healthy control subjects. The insular grey matter abnormalities could be attributed to aggressive behaviour. Moreover, bilateral anterior insular grey matter volume in CD patients correlated significantly with empathy scores. These novel findings point at a joint neuroanatomical substrate underpinning aggressive behaviour and impaired capacity of empathy and suggest a critical role for the anterior insula in regulating social behaviour. [Copyright &y& Elsevier]

Background: It is widely held that aggression and antisocial behavior arise as a consequence of a deficiency in responding to emotional cues in the social environment. We asked whether neural responses evoked by affect-laden pictures would be abnormal in adolescents with conduct disorder (CD). Methods: Functional magnetic resonance imaging during passive viewing of pictures with neutral or strong negative affective valence was performed in 13 male adolescents with severe CD aged 9 to 15 years and in 14 healthy age-matched control subjects. Results: Main effects for negative–neutral affective valence included activations in the amygdala and hippocampus, ventral extrastriate visual cortex, and intraparietal sulcus bilaterally. There was a significant group-by-condition interaction in the right dorsal anterior cingulate cortex that was due to a pronounced deactivation in the patient group during viewing of negative pictures. When correcting for anxiety and depressive symptoms, we additionally found a reduced responsiveness of the left amygdala to negative pictures in patients compared with control subjects. Conclusions: We suggest that these findings reflect an impairment of both the recognition of emotional stimuli and the cognitive control of emotional behavior in patients with CD, resulting in a propensity for aggressive behavior. [Copyright &y& Elsevier]

Objective: Diffusion tensor imaging (DTI) studies in adolescent conduct disorder (CD) have demonstrated white matter alterations of tracts connecting functionally distinct fronto-limbic regions, but only in boys or mixed-gender samples. So far, no study has investigated white matter integrity in girls with CD on a whole-brain level. Therefore, our aim was to investigate white matter alterations in adolescent girls with CD.Method: We collected high-resolution DTI data from 24 girls with CD and 20 typically developing control girls using a 3T magnetic resonance imaging system. Fractional anisotropy (FA) and mean diffusivity (MD) were analyzed for whole-brain as well as a priori-defined regions of interest, while controlling for age and intelligence, using a voxel-based analysis and an age-appropriate customized template.Results: Whole-brain findings revealed white matter alterations (i.e., increased FA) in girls with CD bilaterally within the body of the corpus callosum, expanding toward the right cingulum and left corona radiata. The FA and MD results in a priori-defined regions of interest were more widespread and included changes in the cingulum, corona radiata, fornix, and uncinate fasciculus. These results were not driven by age, intelligence, or attention-deficit/hyperactivity disorder comorbidity.Conclusion: This report provides the first evidence of white matter alterations in female adolescents with CD as indicated through white matter reductions in callosal tracts. This finding enhances current knowledge about the neuropathological basis of female CD. An increased understanding of gender-specific neuronal characteristics in CD may influence diagnosis, early detection, and successful intervention strategies. [ABSTRACT FROM AUTHOR]