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The effects of self-affirmation manipulations are not yet well understood because several different affirmation manipulations have been tested using multiple dependent variables. The aim of the present research was to establish whether global self-feelings and self-esteem, or interpersonal positive feelings are affected by affirming the self. Experiment 1 showed that completing a kindness questionnaire led to adolescent girls reporting more positive interpersonal feelings, but no greater self-feelings or self-esteem than completing an opinions (control) questionnaire. Experiment 2 showed again that self-affirmation did not affect self-esteem, and that there were few differences between writing an essay about a cherished value, writing an essay about kindness, or completing a questionnaire about kindness in boosting positive interpersonal feelings. The findings are discussed in relation to self-affirmation theory and the possible practical implications of self-affirmation for aiding the delivery of social and health messages.

The Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV; American Psychiatric Association, 1994) specifies a developmental relationship between oppositional defiant disorder (ODD) and conduct disorder (CD). Evidence for this link is mixed, however, and recent studies suggest that different symptom dimensions in ODD may have different outcomes. The authors examined links between ODD, CD, and their young adult outcomes in the Great Smoky Mountains Study (E. J. Costello et al., 1996), a longitudinal data set with over 8,000 observations of 1,420 individuals (56% male) covering ages 9-21 years. ODD was a significant predictor of later CD in boys but not in girls after control for comorbid CD and subthreshold CD symptomatology. Transitions between ODD and CD were less common than anticipated, however, particularly during adolescence. The authors examined characteristics and outcomes of children with pure ODD, pure CD, and combined CD/ODD. Alongside many similarities in childhood and adolescent correlates, key differences were also identified: CD largely predicted behavioral outcomes, whereas ODD showed stronger prediction to emotional disorders in early adult life. Factor analysis identified irritable and headstrong dimensions in ODD symptoms that showed differential prediction to later behavioral and emotional disorders. Overall, the results underscore the utility of retaining separate ODD and CD diagnoses in DSM-V.

This book is essential reading for anyone involved in teaching statistics at tertiary level or interested in statistical education research.

Callous and unemotional (CU) traits might usefully subtype DSM-IV conduct disorder (CD). We investigate this hypothesis in a large, nationally representative sample of 5-16-year-olds. We also examine the characteristics of children with high CU traits but without CD.Data come from the 2004 British Child and Adolescent Mental Health Survey including 7,977 children, 5,326 of whom were followed up after 3 years. DSM-IV diagnoses of psychiatric disorder were based on parent, teacher and child report. CU traits were assessed by parent report.Of the 2% of the sample who were diagnosed with DSM-IV CD, 46.1% were high on CU traits. In addition, 2.9% of the sample were high on CU traits without CD. Children with CD and CU traits showed more severe behavioural disturbance and were at substantially higher risk of CD diagnosis 3 years later. Children high on CU traits without CD showed evidence of disturbed functioning.Subtyping CD using CU traits identifies children with more severe and persistent psychopathology. Children with high CU traits but no CD diagnosis require further investigation.

There is likely to be heterogeneity in the processes putting children at risk of injury. This paper examines whether errors may form a dissociable process from risk-taking. We further examine whether these constructs mediate the links between emotional and behavioural problems and unintentional injury. We designed the parent-report Children's Injury Related Behaviour (CIRB) questionnaire to measure errors and risk-taking in everyday activities. The sample consisted of 499 children aged 4-11 years recruited from the community. Principal components analysis showed that a two factor solution was appropriate and provided scales to measure risk and error with good psychometric properties. Both risk and error scales were independently related to injury history. Errors were associated with conduct problems, emotional problems and hyperactivity. Risk-taking was associated with conduct problems and hyperactivity only. Risk-taking and errors accounted for the links of conduct problems and hyperactivity with injury involvement. The distinction between risk and error has implications for research and interventions to reduce childhood injuries.

Introduction Anemia and diabetes are risk factors for short-term mortality following an acute myocardial infarction(AMI). Anemia is more prevalent in patients with diabetes. We performed a retrospective study to assess the impact of the combination of diabetes and anemia on post-myocardial infarction outcomes. Methods Data relating to all consecutive patients hospitalized with AMI was obtained from a population-based disease-specific registry. Patients were divided into 4 groups: diabetes and anemia (group A, n = 716), diabetes and no anemia (group B, n = 1894), no diabetes and anemia (group C, n = 869), and no diabetes and no anemia (group D, n = 3987). Mortality at 30 days and 31 days to 36 months were the main outcome measures. Results 30-day mortality was 32.3% in group A, 16.1% in group B, 21.5% in group C, 6.6% in group D (all p < 0.001). 31-day to 36-month mortality was 47.6% in group A, 20.8% in group B, 34.3% in group C, and 10.4% in group D (all p < 0.001). Diabetes and anemia remained independent risk factors for mortality with odds ratios of 1.61 (1.41–1.85, p < 0.001) and 1.59 (1.38–1.85, p < 0.001) respectively at 36 months. Cardiovascular death from 31-days to 36-months was 43.7% of deaths in group A, 54.1% in group B, 47.0% in group C, 50.8% group D (A vs B, p < 0.05). Interpretation Patients with both diabetes and anemia have a significantly higher mortality than those with either diabetes or anemia alone. Cardiovascular death remained the most likely cause of mortality in all groups.

Background: ICD-10 and DSM-IV include similar criterial symptom lists for conduct disorder (CD) and oppositional defiant disorder (ODD), but while DSM-IV treats each list separately, ICD-10 considers them jointly. One consequence is that ICD-10 identifies a group of children with ODD subtype who do not receive a diagnosis under DSM-IV. Methods: We examined the characteristics of this group of children using the Great Smoky Mountains Study of children in the community aged 9‐16. This study provided child and parent reports of symptoms and psychosocial impairment assessed with standardised diagnostic interviews. Results: Children who received an ICD-10 diagnosis but not a DSM-IV diagnosis showed broadly similar levels of psychiatric comorbidity, delinquent activity and psychosocial impairment to those who met DSM-IV criteria in both cross-sectional and longitudinal analyses. Conclusions: These results indicate that DSM-IV excludes from diagnosis children who receive an ICD-10 diagnosis of CD (ODD sub-type), and who are substantially disturbed. Methods of redressing this situation are considered. Keywords: Oppositional Defiant Disorder, nosology. Abbreviations: DSM: Diagnostic and Statistics Manual; CD: Conduct Disorder; ODD: Oppositional Defiant Disorder; ICD: International Classification of Diseases; CAPA: Child and Adolescent Psychiatric Assessment: ICC: intra-class correlation; ADHD: Attention Deficit Hyperactivity Disorder; GSMS: Great Smoky Mountains Study; POR: proportional odds ratio; OR: odds ratio; CI: confidence interval; DBD NoS: Disruptive Behaviour Disorder Not Otherwise Specified.

Comorbidity between antisocial behavior and depression in adolescence is widely recognized. This paper examines whether links with depressed mood differ among three subtypes of antisocial behavior: oppositionality, physical aggression and delinquency. In addition we examine two possible contributors to these links: negative life events that are dependent upon the individual's actions and depressogenic attributional style. Data are drawn from the G1219 large-scale community twin and sibling sample, and include 2409 questionnaire responses from youths aged between 13 and 19 living in the United Kingdom. Depressed mood was independently associated with both oppositionality and delinquency, but not with physical aggression. Dependent negative life events were strongly implicated in the association between delinquency and depressed mood, whereas depressogenic attributional style was implicated in the associations of both oppositionality and delinquency with depressed mood. Oppositionality remained a significant predictor of depressed mood after accounting for attributional style and life events whereas delinquency did not. The pattern of associations was largely similar in boys and girls. We discuss these results in terms of developmental models of the links between antisocial behavior and depressed mood.

Glycemic control using inhaled, dry-powder insulin plus a single injection of long-acting insulin was compared with a conventional regimen in patients with type 2 diabetes, which was previously managed with at least two daily insulin injections.Patients were randomized to 6 months' treatment with either premeal inhaled insulin plus a bedtime dose of Ultralente (n = 149) or at least two daily injections of subcutaneous insulin (mixed regular/NPH insulin; n = 150). The primary efficacy end point was the change in HbA1c from baseline to the end of study.HbA1c decreased similarly in the inhaled (-0.7%) and subcutaneous (-0.6%) insulin groups (adjusted treatment group difference: -0.07%, 95% CI -0.32 to 0.17). HbA1c7.0% was achieved in more patients receiving inhaled (46.9%) than subcutaneous (31.7%) insulin (odds ratio 2.27, 95% CI 1.24-4.14). Overall hypoglycemia (events per subject-month) was slightly lower in the inhaled (1.4 events) than in the subcutaneous (1.6 events) insulin group (risk ratio 0.89, 95% CI 0.82-0.97), with no difference in severe events. Other adverse events, with the exception of increased cough in the inhaled insulin group, were similar. No difference in pulmonary function testing was seen. Further studies are underway to assess tolerability in the longer term. Insulin antibody binding increased more in the inhaled insulin group. Treatment satisfaction was greater in the inhaled insulin group.Inhaled insulin appears to be effective, well tolerated, and well accepted in patients with type 2 diabetes and provides glycemic control comparable to a conventional subcutaneous regimen.

OBJECTIVE: We set out to examine the relationship between unintentional injury and common child psychiatric disorders, including both internalizing and externalizing diagnoses. METHODS: The 1999 British Child and Adolescent Mental Health Survey provided a nationally representative sample of over 10,000 children aged 5-15 years. Measures included assessment of diagnoses of psychiatric disorder from the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, unintentional injury, and a range of potentially related psychosocial factors. RESULTS: Children with psychiatric disorders had higher rates of unintentional injury. After accounting for psychosocial risk factors and comorbid psychopathology, oppositional defiant disorder (ODD) was independently associated with burns and poisoning. Attention deficit hyperactivity disorder (ADHD) was related to fractures, and depression and anxiety also showed independent links to some injury types. CONCLUSIONS: ODD and ADHD, rather than conduct disorder, appear to be the externalizing disorders associated with unintentional injury. We discuss possible models of the relationships between internalizing disorders and unintentional injury. Language: en

Background: Despite an expanding epidemiological evidence base, uncertainties remain over key aspects of the epidemiology of the ‘antisocial’ disorders in childhood and adolescence. Methods: We used cross-sectional data on a nationally representative sample of 10,438 5–15-year-olds drawn from the 1999 British Child Mental Health Survey to examine age trends, gender ratios and patterns of comorbidity in DSM-IV Conduct Disorder (CD) and Oppositional Defiant Disorder (ODD). Results: CD was significantly more common in boys than girls, and increased in prevalence with age. Among children who met diagnostic criteria for CD, status violations and other non-aggressive conduct problems increased with age, while aggressive symptoms became less common. Gender differences in ODD varied by reporter. Estimates of age trends in ODD depended heavily on treatment of overlaps with CD. Following DSM-IV guidelines (where ODD is not diagnosed in the presence of CD), rates of ODD fell with age; if that constraint was released, clinically significant rates of oppositionality persisted at similar levels from early childhood to middle adolescence. CD and ODD showed high levels of overlap, and both diagnoses showed substantial comorbidity with other non-antisocial disorders. Conclusions: Results from this large-scale study confirm and extend previous findings in the epidemiology of the disruptive behaviour disorders.

Although reading difficulties show well-established overlaps with disruptive behavior disorders in childhood, much less is known about reading-disabled children's vulnerability to emotional difficulties. Using longitudinal data from 6 assessments of boys in the Pittsburgh Youth Study, we found robust links between severe, persistent reading problems and increased risk for depressed mood in a community sample of boys aged 7 and 10 years at initial assessment, though not in those who had already entered their teens. These associations could not be accounted for in terms of selected family risks or comorbid disruptive behaviors; instead, the pattern of the findings pointed to the existence of more direct causal processes whereby reading problems influence younger boys' risk of depressed mood.

In this research, we sought to test the hypothesis that the AccuTouch Flexible Bronchoscopy Simulator (Simulator) is an effective way to teach clinicians the psychomotor skills necessary to use the fiberoptic bronchoscope as an instrument for intubating the trachea of a pediatric patient. Pediatric residents with no prior experience in fiberoptic bronchoscopy were studied. Residents performed fiberoptic intubation on children undergoing general anesthesia. Tapes of these intubations were analyzed for: time to visualization of the carina, and number and time that the bronchoscope tip hit the mucosa. Residents were then trained on the Simulator. Performance of fiberoptic intubation on a subsequent child was compared. Training on the Simulator was the only instruction that the residents received between the two cases. A control group of residents performed two consecutive intubations without training on the Simulator between cases. Residents studied an average of 17 cases, and spent 39 min on the Simulator. Performance was markedly improved after the Simulator. Time to completion of successful intubation with a bronchoscope was reduced from 5.15 to 0.88 min (P0.001). The number of times that the tip of the bronchoscope hit the mucosa was reduced from 21.4 to 3.0 (P0.001). The amount of time that the resident spent viewing the mucosa decreased from 2.24 to 0.19 min (P0.001). The percent of time viewing the channel of the airway increased from 58.5% to 80.4% (P = 0.004). This bronchoscopy simulator was very effective in teaching residents the psychomotor skills necessary for fiberoptic intubation. Significant improvement was seen in time to completion of endotracheal intubation, as well as other performance indicators.This research showed that the AccuTouch Bronchoscopy Simulator is an effective way to teach the psychomotor skills necessary to intubate the trachea of patients using a fiberoptic bronchoscope. The residents that practiced on the Simulator dramatically improved their skills compared with a control group of residents.

Background: We examine models of the relationship between oppositional defiant disorder (ODD) and conduct disorder (CD) in a community sample. Particular attention is paid to the generalisability of findings based on clinic-referred boys. Methods: The analyses were based on four waves of data from the Great Smoky Mountains Study covering children in the community aged 9‐16 years. Child and parent reports of DSM-IV symptoms, diagnoses, and a range of family and environmental adversities were collected using the Child and Adolescent Psychiatric Assessment. Results: Cross-sectional analyses indicated that CD and ODD largely shared similar correlates, although some aspects of parenting appeared more related to CD than ODD. This pattern was broadly similar in boys and girls. Longitudinal analyses confirmed that ODD was a strong risk factor for CD in boys and there was a suggestion that ODD was a stronger risk factor for CD than for other common disorders. Atypical family structure was an important factor in the transition between ODD and CD in boys. In girls ODD provided no increased risk for later CD but was associated with increased risk for continued ODD, depression, and anxiety. Conclusions: These results are more consistent with a developmental relationship between ODD and CD in boys than girls. Keywords: Anti-social behaviour, conduct disorder, development, epidemiology, prognosis, risk-factors.

Background music can influence everyday behaviour. We examined the influence of music tempo and genre on roulette. Fast tempo and popular music resulted in quicker betting with no effect on expenditure. Subjective arousal did not mediate music tempo's effects. Alternative mechanisms underlying music's influence on gambling and directions for future research are considered.

Objective To examine prevalence and demographic relationships of different areca nut habits amongst children. Design Self-administered questionnaire. Subjects Children aged between 11 and 15. Of 800 questionnaires distributed, 704 were fully completed (88%). Setting Two secondary schools in the London district of Tower Hamlets. Measures Demographic, areca nut habits used, age first used, still using, frequency of use. Results Users of any areca nut habit were exclusively from the South Asian population. Of this population, 77% had engaged in a habit, and dependent upon habit between 54 and 92% of these still remained current users. The highest prevalence of current use for boys and girls respectively was for areca nut alone (36%, 43%), followed by mistee pan (35%, 29%), betel-quid (27%, 26%) and pan masala (14%, 16%). Of the current users, 44% engaged in one habit only, 24% two, 20% three and 13% all four. The highest period of risk for starting to use areca nut alone, betel-quid and mistee pan was between ages 5 and 12, whilst for pan masala it was after 10. Boys had a significantly higher risk of beginning use before 10 (P < .001) and a higher frequency of use for pan masala (P < .01), areca nut alone (P < .05) and betel-quid (P = .06) than girls. The frequency of using each habit was between 3 and 5 episodes per week, however boys use pan masala approximately 10 times per week. Conclusion South Asian children may already be experienced users of areca nut. Greater attention should be directed towards identifying signs of oral submucous fibrosis, oral cancer and other potentially malignant lesions within the South Asian population.

Purpose: This article discusses the importance of the process of evaluation of clinical teaching for the individual teacher and for the programme. Measurement principles, including validity, reliability, efficiency and feasibility, and methods to evaluate clinical teaching are reviewed. Context: Evaluation is usually carried out from the perspective of the learner. This article broadens the evaluation to include the perspectives of the teacher, the patient and the institutional administrators and payers in the health care system and recommends evaluation strategies. Results: Each perspective provides specific feedback on factors or attributes of the clinical teacher’s performance in the domains of medical expert, professional, scholar, communicator, collaborator, patient advocate and manager. Teachers should be evaluated in all domains relevant to their teaching objectives; these include knowledge, clinical competence, teaching effectiveness and professional attributes. Conclusions and implications: Using this model of evaluation, a connection can be made between teaching and learning about all the expected roles of a physician. This can form the basis for systematic investigation into the relationship between the quality of teaching and the desired outcomes, the improvement of student learning and the achievement of better health care practice. It is suggested that the extent of effort and resources devoted to evaluation should be commensurate with the value assigned to the evaluation process and its outcomes.

6113 Background: Adverse publicity about smoking may lead to feelings of guilt among lung cancer patients or pessimism about their future, potentially compromising health-related quality of life (QoL) and adherence with medical advice. QoL is an important outcome in clinical trials, particularly where survival rates are low. We aim to compare QoL and illness perceptions of lung cancer patients depending on smoking history. Methods: Clinical data, measures of QoL (EORTC-QLQ-C30+LC13) and illness perceptions (Brief IPQ – includes items to assess perceived severity, causality, timeline, understanding, emotional impact, and control over illness) were completed by 190 newly diagnosed lung cancer patients (Non-small cell: 75%; Mean age: 68 years, range: 48-85 years; 58% males). Of these, 24% were current smokers, 69% former smokers, and 7% never smoked. Results: Although overall QoL was similar between the three smoker groups, there was a significant effect of smoking status on QoL subscale emotional function (EF)(F(2,168)=4.08,p=.019). Those who never smoked had significantly higher EF than current smokers (p=.03). There was also a significant effect of smoking history on cough (F(2,166);=5.40 ,p=.005) with smokers reporting significantly greater levels than former smokers (p=.004). Smokers were more likely than former smokers (p=.015) to attribute their lung cancer to smoking (F(2,161)=16.49,p

ECENT IMPROVEMENTS in the instruments for R and the technique of video-assisted thoracoscopy in adults have resulted in increased use of thoracoscopy.l Reported advantages of thoracoscopy include smaller thoracic incisions, reduced postoperative pain, and faster postoperative recovery.2 The descriptions of anesthetic techniques used for thoracoscopy pertain only to adults.2-4 Because thoracoscopy is now used in the pediatric population,5,6 the detailed anesthetic management for thoracoscopy in nine pediatric patients, with emphasis on methods of one-lung ventilation in children, is reported.

Background Until quite recently spinal disorder problems in the U.S. have been operated by fusing cervical vertebrae instead of replacement of the cervical disc with an artificial disc. Cervical disc replacement is a recently approved procedure in the U.S. It is one of the most challenging surgical procedures in the medical field due to the deficiencies in available diagnostic tools and insufficient number of surgical practices For physicians and surgical instrument developers, it is critical to understand how to successfully deploy the new artificial disc replacement systems. Without proper understanding and practice of the deployment procedure, it is possible to injure the vertebral body. Mixed reality (MR) and virtual reality (VR) surgical simulators are becoming an indispensable part of physicians’ training, since they offer a risk free training environment. In this study, MR simulation framework and intricacies involved in the development of a MR simulator for the rasping procedure in artificial cervical disc replacement (ACDR) surgery are investigated. The major components that make up the MR surgical simulator with motion tracking system are addressed. Findings A mixed reality surgical simulator that targets rasping procedure in the artificial cervical disc replacement surgery with a VICON motion tracking system was developed. There were several challenges in the development of MR surgical simulator. First, the assembly of different hardware components for surgical simulation development that involves knowledge and application of interdisciplinary fields such as signal processing, computer vision and graphics, along with the design and placements of sensors etc . Second challenge was the creation of a physically correct model of the rasping procedure in order to attain critical forces. This challenge was handled with finite element modeling. The third challenge was minimization of error in mapping movements of an actor in real model to a virtual model in a process called registration. This issue was overcome by a two-way (virtual object to real domain and real domain to virtual object) semi-automatic registration method. Conclusions The applicability of the VICON MR setting for the ACDR surgical simulator is demonstrated. The main stream problems encountered in MR surgical simulator development are addressed. First, an effective environment for MR surgical development is constructed. Second, the strain and the stress intensities and critical forces are simulated under the various rasp instrument loadings with impacts that are applied on intervertebral surfaces of the anterior vertebrae throughout the rasping procedure. Third, two approaches are introduced to solve the registration problem in MR setting. Results show that our system creates an effective environment for surgical simulation development and solves tedious and time-consuming registration problems caused by misalignments. Further, the MR ACDR surgery simulator was tested by 5 different physicians who found that the MR simulator is effective enough to teach the anatomical details of cervical discs and to grasp the basics of the ACDR surgery and rasping procedure

Catecholamines induce unique growth and secretory responses in salivary glands. An analysis of three enzyme activities involved in cyclic AMP metabolism was carried out to identify the specificity of these responses for salivary glands. Although parotid adenylate cyclase has an unusually high specific activity, its kinetic properties and responses to NaF, guanine nucleotides, and isoproterenol are similar to other tissues not stimulated to grow after isoproterenol stimulation. Solubilized adenylate cyclase was separated from other membrane proteins by isoelectric focusing on polyacrylamide gels. There was a single broad peak of activity with a pI of 5.9. Parotid protein kinase has a subcellular distribution and substrate preference similar to hepatic protein kinase. Activation by cyclic AMP is also similar to that reported for other tissues, with a K a of 1.2·10 −7 M. Parotid cyclic AMP and cyclic GMP phosphoriesterases are a heterogeneous group of enzymes with relatively low specific activity as compared with mouse pancreas, liver and brain. Isoelectric focusing of supernatant phosphodiesterases revealed at least six peaks of enzyme activity in the pI range of 4–6. Previous reports of a large increase in parotid cyclic AMP levels after in vivo administration of catecholamines and specific growth and secretion could be the result of a relatively high specific activity adenylate cyclase associated with low specific activity cyclic AMP phosphodiesterases.

Overlapping genetic influences have been implicated in diurnal preference and subjective sleep quality. Our overall aim was to examine overlapping concurrent and longitudinal genetic and environmental effects on diurnal preference and sleep quality over ~5 years. Behavioral genetic analyses were performed on data from the longitudinal British G1219 study of young adult twins and nontwin siblings. A total of 1556 twins and siblings provided data on diurnal preference (Morningness-Eveningness Questionnaire) and sleep quality (Pittsburgh Sleep Quality Index) at time 1 (mean age = 20.30 years, SD = 1.76; 62% female), and 862 participated at time 2 (mean age = 25.30 years, SD = 1.81; 66% female). Preference for eveningness was associated with poorer sleep quality at both time points ( r = 0.25 [95% confidence intervals {CIs} = 0.20-0.30] and r = 0.21 [CI = 0.15-0.28]). There was substantial overlap in the genetic influences on diurnal preference and sleep quality individually, across time (genetic correlations [rAs]: 0.64 [95% CI = 0.59-0.67] and 0.48 [95% CI = 0.42-.053]). There were moderate genetic correlations between diurnal preference and sleep quality concurrently and longitudinally (rAs = 0.29-0.60). Nonshared environmental overlap was substantially smaller for all cross-phenotype associations (nonshared environmental correlations (rEs) = -0.02 to 0.08). All concurrent and longitudinal associations within and between phenotypes were largely accounted for by genetic factors (explaining between 60% and 100% of the associations). All shared environmental effects were nonsignificant. Nonshared environmental influences played a smaller role on the associations between phenotypes (explaining between -0.06% and 40% of the associations). These results suggest that to some extent, similar genes contribute to the stability of diurnal preference and sleep quality throughout young adulthood but also that different genes play a part over this relatively short time frame. While there was evidence of genetic overlap between phenotypes concurrently and longitudinally, the possible emergence of new genetic factors (or decline of previously associated factors) suggests that molecular genetic studies focusing on young adults should consider more tightly specified age groups, given that genetic effects may be time specific.

Background The relationship between social position and physical health is well-established across a range of studies. The evidence base regarding social position and mental health is less well developed, particularly regarding the development of antisocial behavior. Some evidence demonstrates a social gradient in behavioral problems, with children from low-socioeconomic backgrounds experiencing more behavioral difficulties than children from high-socioeconomic families. Antisocial behavior is a heterogeneous concept that encompasses behaviors as diverse as physical fighting, vandalism, stealing, status violation and disobedience to adults. Whether all forms of antisocial behavior show identical social gradients is unclear from previous published research. The mechanisms underlying social gradients in antisocial behavior, such as neighborhood characteristics and family processes, have not been fully elucidated. This review will synthesize findings on the social gradient in antisocial behavior, considering variation across the range of antisocial behaviors and evidence regarding the mechanisms that might underlie the identified gradients. Methods In this review, an extensive manual and electronic literature search will be conducted for papers published from 1960 to 2011. The review will include empirical and quantitative studies of children and adolescents ( Discussion This systematic review has been proposed in order to synthesize cross-disciplinary evidence of the social gradient in antisocial behavior and mechanisms underlying this effect. The results of the review will inform social policies aiming to reduce social inequalities and levels of antisocial behavior, and identify gaps in the present literature to guide further research.