Familial risk factors to oppositional defiant disorder and conduct disorder: parental psychopathology and maternal parenting.

In a sample of 177 clinic-referred children aged 7-13, an association was found between a diagnosis of conduct disorder (CD) and several aspects of family functioning: maternal parenting (supervision and persistence in discipline) and parental adjustment (paternal antisocial personality disorder and paternal substance abuse). Children with oppositional defiant disorder (ODD) were intermediate to families of children with CD and clinic control children on all variables, but differed from control children only in having a higher rate of paternal substance abuse and paternal antisocial personality disorder (APD). When both parental APD and deviant maternal parenting were entered into 2 x 2 logit-model analyses predicting CD, only parental APD was significantly associated with CD, and no interactions between parental adjustment and maternal parenting were found. The importance of these findings for understanding the etiology of CD and for disentangling correlated risk factors in future studies is discussed.     

Correlates of distress in children at risk for affective disorder: exploring predictors in the offspring of depressed and nondepressed mothers

BACKGROUND: Efforts to understand the correlates of psychological distress in children frequently examine possible correlates in samples of children who are selected for high levels of distress. The propose of this study was to compare distress correlates in a sample with depressed mothers, and thus at high-risk for distress, to a low-risk sample. METHODS: Examining data from part of a larger project, the association of children's depressive symptoms and internalizing and externalizing problems to maternal depression level, life stress, verbal ability, and the experience of a traumatic event were examined in a series of regression equations. RESULTS: Results indicated that children's depressive symptoms, rather than internalizing and externalizing problems, tended to be most consistently related to maternal variables, and also suggested that any experience of maternal depressive symptoms was associated with child problems. It was also found that child depressive symptoms were correlated with life events, but only for nondepressed mothers, and that at-risk children with higher levels of verbal ability were significantly less likely to report experiencing depressive symptoms and internalizing problems than were those with lower levels of verbal ability. LIMITATIONS: Because these data are preliminary, further research examining a broader array of variables is important. CONCLUSIONS: These results suggest the need for different models of these processes in different populations of children.     

Social status and the comorbidity of child depression and conduct disorder

This study examined the overlap between child depression and conduct disorder (D&CD) as a function of peer social status (i.e., popular, rejected, neglected, controversial, average) in a sample of 1,464 nonreferred 4th graders. Both D&CD were measured by self-report, peer nomination, and teacher ratings. Social status was assessed by peer nomination. A strong correlation (.73) was found between D&CD, even after accounting for shared method variance by confirmatory factor analysis. Furthermore, the number of Ss who scored high on both D&CD was greater than would be expected by chance alone. Multivariate tests revealed that rejected Ss scored higher than average Ss on measures of D&CD. Controversial boys also scored higher on measures of CD. However, analyses also revealed that the association between depression and rejected social status might be due to a subgroup of depressed children who also manifested symptoms of CD. Implications for assessment and treatment of child disorders are discussed.     

A controlled longitudinal 5-year follow-up study of children at high and low risk for panic disorder and major depression

BACKGROUND: To evaluate the longitudinal course of psychiatric disorders in children of parents with panic disorder (PD) and major depression (MD) as they transition through the period of risk from childhood into adolescence. METHOD: Over a 5-year follow-up, we compared psychiatric disorders in four groups of children: (1) offspring of parents with PD plus MD (n=136); (2) offspring of parents with PD without MD (n=27); (3) offspring of parents with MD but without PD (n=53); and (4) offspring of non-PD non-MD parents (n=103). RESULTS: Parental PD was significantly associated with increased risk for anxiety disorders, irrespective of parental MD. Parental MD was associated with increased risk for MD, disruptive behavior disorders, and deficits in psychosocial functioning, irrespective of parental PD. CONCLUSIONS: These longitudinal findings confirm and extend previous cross-sectional results documenting significant associations between PD and MD in parents and patterns of psychopathology and dysfunction in their offspring.     

Maternal mood and sleep in children of women at risk for perinatal depression

Few studies have examined relationships between perinatal depression and sleep in offspring beyond very early childhood. Eighty-five women classified as high risk for major depressive disorder during pregnancy completed measures of mood and their child’s sleep 4–7 years postpartum. Mothers with Beck Depression Inventory-II (BDI-II) scores ≥20 reported more sleep problems in their child, and child sleep disruption was a reasonable predictor of maternal BDI-II. More research is needed to determine causal relationships between perinatal depression and sleep in offspring.     

Adolescent conduct disorder and interpersonal callousness as predictors of psychopathy in young adults.

Unfortunately, very little research has examined the link between antisocial personality traits in childhood and adult psychopathy. This study used data from a clinic-referred sample of 177 boys, assessed annually from recruitment (ages 7 to 12) through age 19. Parent and teacher ratings of interpersonal callousness (IC) were tested at predictors of psychopathy ratings at 18 and 19. In regression models, conduct disorder (CD) and teacher-rated IC both predicted both Factor 1 (interpersonal and affective items) and Factor 2 (impulsivity and antisocial behavior items) of the Psychopathy Checklist-Revised, as did child IQ. Prenatal tobacco exposure and cortisol measured in adolescence predicted only Factor 1. When each factor was included in the prediction of the other, CD and IC no longer predicted Factor 1 but remained significant predictors of Factor 2.     

Potential mediators of cognitive-behavioral therapy for adolescents with comorbid major depression and conduct disorder

Several possible mediators of a group cognitive-behavioral therapy (CBT) for depressed adolescents were examined. Six measures specific to CBT (e.g., negative cognitions, engagement in pleasurable activities) and 2 nonspecific measures (therapeutic alliance, group cohesion) were examined in 93 adolescents with comorbid major depressive disorder and conduct disorder who were randomly assigned to the Adolescent Coping With Depression (CWD-A) course or a life skills control condition. Change on the Automatic Thoughts Questionnaire (S. D. Hollon & P. C. Kendall, 1980) appeared to mediate treatment effects on depressive symptoms. Therapeutic alliance by the 3rd session was higher among the CWD-A participants but did not predict reductions in depressive symptoms. Findings suggest that reducing negative thinking may be the primary mechanism through which the CWD-A intervention reduces depression.     

The outcome of childhood conduct disorder: implications for defining adult personality disorder and conduct disorder.

The effect of conduct disorder on adult social functioning in the areas of work, sexual/love relationships, social relationships and criminality was studied in a sample of young adults who spent much of their childhoods in group-cottage children's homes and an inner-city comparison group. Most subjects with conduct disorder had pervasive (but not necessarily severe) social difficulties compared to peers without conduct disorder. Less than half of this group met DSM-III adult criteria for antisocial personality disorder and just over half were given a diagnosis of personality disorder on interviewer clinical ratings. A latent class model that used both the retrospective and contemporaneous indicators of conduct disorder confirmed the very high continuity with adult social difficulties. Current diagnoses did not adequately describe this group and conduct disorder appeared to be an almost necessary condition for multiple social disability in adults in these samples.     

Postural sway and perception of affordances in children at risk for developmental coordination disorder

Gibson (The ecological approach to visual perception, Houghton Mifflin, Boston, 1979/1986) defined affordances as opportunities for motor behaviors, and highly emphasized the interaction between perception and action. Research on children with developmental coordination disorder commonly reports difficulties in judgments of affordances (perception) and in postural control (action). However, how perception and action are coupled has not been studied yet. The present study sought to evaluate the relationship between control of postural sway and perception of affordances in children at risk for developmental coordination disorder (RDCD) and typically developing children (TDC). We hypothesized that the relationship between perception and action would differ between groups. Participants made a series of judgments about their maximum sitting height (SHmax) while standing with and without wearing 10 cm blocks on feet. Postural sway and the judgment accuracy were recorded. Our findings showed that RDCD swayed more during judgment sessions and made less accurate judgments compared to TDC. In addition, TDC reduced postural sway from inter-judgment to judgment sessions, whereas the postural sway of RDCD remained identical between sessions. Last, while TDC reduced postural sway across judgment trials and revealed a learning effect of the judgments about SHmax in the block condition, RDCD never modulated postural sway and did not learn their SHmax in both non-block and block conditions. Overall, modulation of postural sway differed between groups during judgment sessions and between inter-judgment and judgment sessions, whereby their perceptual judgments about SHmax were differentially influenced. To summarize, this study demonstrated a difference in perception and action coupling between RDCD and TDC.     

Familial aggregation for conduct disorder symptomatology: the role of genes, marital discord and family adaptability

BACKGROUND: There is extensive evidence of statistical associations between family discord/ maladaptation and antisocial behaviour in the children, but questions remain on the extent to which the psychopathological risks are genetically or environmentally mediated. METHODS: Twin pairs (N = 1,350), aged 8 to 16 years, in the general population-based Virginia Twin Study of Adolescent Behavioral Development were assessed using the Child and Adolescent Psychiatric Assessment interview administered separately to both twins and both parents. Structured interviews for parental lifetime psychiatric disorders were also administered to the mothers and fathers. Maternal reports on Olsson's Family Adaptability and Cohesiveness questionnaire and the Dyadic Adjustment Scale were used as indices of the family environment. A path analytical model based on an extended twin-family design was used to test hypotheses about parent offspring similarity for conduct disorder symptomatology. RESULTS: Family discord and maladaptation, which intercorrelated at 0.63, were associated with a roughly two-fold increase in risk for conduct disorder symptomatology. When parental conduct disorder was included in the model the environmental mediation effect for family maladaptation remained, but that for family discord was lost. CONCLUSION: It is concluded that there is true environmental mediation from family maladaptation, operating as a shared effect, which accounts for 3.5 % of the phenotypic variance. The assumptions underlying this genetic research strategy are made explicit, together with its strengths and limitations.     

Familial hypercholesterolaemia: pilot study to identify children at risk.

AIMS--To evaluate a more effective method of identifying children with familial hypercholesterolaemia by screening a population at high risk. METHODS--Domiciliary measurement of random cholesterol concentration was made in 200 children who were first or second degree relatives of subjects with premature onset coronary artery disease. Measurements were taken by a health visitor using a portable analyser. RESULTS--Twelve new cases of familial hypercholesterolaemia were identified during the first nine months of the study. Random cholesterol concentrations were within the normal range (< 5.2 mmol/l) in 70.5% of samples tested. Forty two (21%) of patients tested had a borderline cholesterol (5.2-5.9 mmol/l) but 50% of these fell within the normal range when fasting capillary samples were analysed. Children with significant hypercholesterolaemia on random testing (concentrations of > 5.9 mmol/l) (8.5%) also had fasting venous blood assayed for high density lipoprotein (HDL) cholesterol and tri-glyceride in the laboratory. Results indicated that 6.5% of patients screened were at high risk of cardiovascular disease (ratio of total: HDL cholesterol of > 4.5), and 1% had a moderately increased risk (ratio 3.5-4.5). CONCLUSIONS--Children with familial hypercholesterolaemia can be identified from a selected "high risk" population by measuring random capillary cholesterol concentration.     

Genotype and neuropsychological response inhibition as resilience promoters for attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder under conditions of psychosocial adversity

Whereas child personality, IQ, and family factors have been identified as enabling a resilient response to psychosocial adversity, more direct biological resilience factors have been less well delineated. This is particularly so for child attention-deficit/hyperactivity disorder (ADHD), which has received less attention from a resilience perspective than have associated externalizing disorders. Children from two independent samples were classified as resilient if they avoided developing ADHD, oppositional defiant disorder (ODD), or conduct disorder (CD) in the face of family adversity. Two protective factors were examined for their potential relevance to prefrontal brain development: neuropsychological response inhibition, as assessed by the Stop task, and a composite catecholamine genotype risk score. Resilient children were characterized in both samples by more effective response inhibition, although the effect in the second sample was very small. Genotype was measured in Sample 1, and a composite high risk genotype index was developed by summing presence of risk across markers on three genes expressed in prefrontal cortex: dopamine transporter, dopamine D4 receptor, and noradrenergic alpha-2 receptor. Genotype was a reliable resilience indicator against development of ADHD and CD, but not ODD, in the face of psychosocial adversity. Results illustrate potential neurobiological protective factors related to development of prefrontal cortex that may enable children to avoid developing ADHD and CD in the presence of psychosocial adversity.     

Atypical development of resting respiratory sinus arrhythmia in children at high risk for depression

Compromised respiratory sinus arrhythmia (RSA, i.e., low cardiac vagal control) frequently characterizes clinically depressed adults and also has been detected in infants of depressed mothers; however, its existence has not been established in older at-risk offspring. We investigated developmental patterns of RSA in a sample of 163 5- to 14-year-old children, who were either at high risk for depression (due to having a parent with a childhood-onset mood disorder) or low-risk for depression. We hypothesized that high-risk children have lower resting RSA than do low-risk children, which could reflect atypical developmental trajectories. Children's RSA was assessed during resting baseline periods on multiple occasions, typically 1-year apart. Linear growth modeling indicated a group by age interaction. Low-risk children (but not the high-risk children) exhibited a significantly increasing trajectory in resting RSA with age. Mood disorders in offspring did not account for the Group X Age interaction effect. Our study provides new evidence that children at high risk for depression have an atypical developmental trajectory of RSA across late childhood.     

Rumination in adolescents at risk for depression

BACKGROUND: Identifying high-risk adolescents and understanding first onset of depression in adolescence are important steps in reducing depression morbidity. There is compelling evidence that the personality dimension neuroticism is a risk factor for depression, but the vulnerability mechanism is not yet understood. This study examined the association between a hypothesized psychological vulnerability factor (rumination) and depression in adolescents. METHODS: A behavioural high-risk design differentiated a sample of 326 adolescents (aged 14-18) as either at normal or high risk for depression (operationalized as scores on a measure of neuroticism). RESULTS: Adolescents at risk for depression reported more rumination than adolescents not at risk. We hypothesized that the well established relationship between neuroticism and depression would be mediated by rumination in cross-sectional analyses, and our findings suggest that rumination partially mediated this relationship. CONCLUSIONS: The findings tentatively suggest that neuroticism acts as a risk factor for adolescent onset depression through increased tendency towards brooding rumination (i.e. moody self-evaluative dwelling) in response to depressed mood. Prospective and experimental research examining this mechanism is required.     

Depressive conduct disorder: symptom patterns and correlates in referred children and adolescents

BACKGROUND: In order to examine the validity of the ICD-10 diagnostic category of depressive conduct disorder (DCD), a sample of 58 patients (mean age 11.6) with this diagnosis consecutively referred to a teaching hospital was compared with 151 patients with conduct disorder (CD) (mean age 12.3) and with 128 patients with depressive disorder (DD) (mean age 14.2). METHOD: Data on symptom profile, sociodemographic characteristics, duration of disorder, family history and psychosocial background were collected using the Maudsley item sheet. Comparison of the three groups was performed using SPSS. RESULTS: Controlling for age and gender differences, the DCD group had fewer biological depressive symptoms, fewer anxiety symptoms, less guilt and lower severity of overall depression compared to the DD group. They also displayed more self-injurious behaviour and had more adverse psychosocial circumstances than the DD subjects. Compared to the CD group, the DCD patients were less overtly aggressive and violent than the CD subjects, in addition to having significant depressive symptoms and a more frequent history of abuse. LIMITATIONS: The study was based on case-control and diagnosis had been reached after the discussion of clinicians involved in assessment. CONCLUSIONS: Overall, the results tentatively support the validity of this diagnostic subgrouping.     

Developmental changes in startle reactivity in school-age children at risk for and with actual anxiety disorder

The present study examined the development of elevated startle reactivity in anticipation of mild anxiogenic procedures in school-age children with current anxiety disorders and in those at-risk for their development due to parental anxiety. Startle blink reflexes and skin conductance responses were assessed in 7 to 12 year old anxious children (N = 21), non-anxious children at-risk for anxiety by virtue of parental anxiety disorder status (N = 16) and non-anxious control children of non-anxious parents (N = 13). Responses were elicited by 28 auditory startle stimuli presented prior to undertaking mild anxiogenic laboratory procedures. Results showed that group differences in startle reactivity differed as a function of children's age. Relative to control children for whom age had no effect, startle reflex magnitude in anticipation of anxiogenic procedures increased across the 7 to 12 years age range in children at-risk for anxiety disorders, whereas elevations in startle reactivity were already manifest from a younger age in children with anxiety disorders. These findings may suggest an underlying vulnerability that becomes manifest with development in offspring of anxious parents as the risk for anxiety disorders increases.