The Predictive Validity of Risk Assessment Approaches for Young Australian Offenders

Validation literature on the predictive ability of North American youth violence risk assessment inventories is developing across international settings. Yet no information exists on the utility of the Structured Assessment of Violence Risk in Youth (SAVRY) and the Psychopathy Checklist: Youth Version (PCL:YV),]and little research has been conducted on the Youth Level of Service/Case Management Inventory (YLS/CMI) across Australian young offender populations. The current study investigated the validity of the risk instruments on 213 young people in detention in Victoria, Australia. Findings indicated moderate to strong predictive accuracy for re-offence outcomes across the three inventories for the total sample and for males. The SAVRY was also able to identify the strength of protective factors for young female offenders. The inventories appear to be suitable prediction aides in the Australian youth justice context although further research is required to ascertain their applicability to Australian young female offenders.     

ADHD and Conduct Disorder: An MRI Study in a Community Sample

Summary: MRI studies of children with Attention-Deficit Hyperactivity Disorder (ADHD) have consistently attributed core deficits of inattention and impulsivity to frontal-striatal-cerebellar abnormalities; however, no study has investigated the neuroanatomical characteristics of children with ADHD and Conduct Disorder (CD). This study examined a community sample of 12 children with combined subtype ADHD (aged 8-12, 7 with CD) and 19 healthy controls matched for age, gender, handedness and poverty. Volume measurements, including left/right asymmetries, were quantified from MRI of the total brain, caudate and cerebellar vermis. No significant differences in total brain volume, caudate volume, asymmetry of the hemispheres or asymmetry of the caudate were found between the groups. Measurements of the left and total posterior superior and inferior lobes of the vermis, however, indicated smaller volumes for both pure ADHD and co-morbid children compared to the controls. Analysis of variance demonstrated no significant volumetric differences between the pure ADHD and co-morbid types. Prolonged exposure to methylphenidate was associated with caudate volumes. These results suggest ADHD and ADHD co-morbid with CD have similar deviant cerebellar morphology and replicate previous studies with an epidemiologically derived sample.     

Psychopathy and offence severity in sexually aggressive and violent youth

Background A large proportion of violent crimes are committed by youths. Youths with psychopathic traits may have a higher risk for recidivism and violence. Aims/hypotheses Our aim was to compare sexually aggressive with violent young men on offence severity and psychopathy. Three hypotheses were proposed: first, young men with previous offences would display a progressive increase in seriousness of offence during their criminal career; secondly, the sexually aggressive and violent young men would not differ in scores on the Hare Psychopathy Checklist: Youth Version (PCL:YV); but, thirdly, PCL:YV scores would be positively correlated with the severity of the index crime, as measured by the Cormier–Lang System for Quantifying Criminal History. Methods Information was collected from the files of 40 young men in conflict with the law, and the PCL:Youth Version (YV) rated from this by trained raters. Results The offences of these young men became more serious over time, but we found no association between PCL:YV scores and offence type or seriousness. Conclusions and implications This exploratory research suggests the importance of understanding the progression in offending careers, but a limited role for the PCL:YV in doing so. Given the small sample size, however, and the limit on access to information about details of age, the findings need replication. Copyright © 2009 John Wiley & Sons, Ltd.     

ADHD and conduct disorder: an MRI study in a community sample.

MRI studies of children with Attention-Deficit Hyperactivity Disorder (ADHD) have consistently attributed core deficits of inattention and impulsivity to frontal-striatal-cerebellar abnormalities; however, no study has investigated the neuroanatomical characteristics of children with ADHD and Conduct Disorder (CD). This study examined a community sample of 12 children with combined subtype ADHD (aged 8-12, 7 with CD) and 19 healthy controls matched for age, gender, handedness and poverty. Volume measurements, including left/right asymmetries, were quantified from MRI of the total brain, caudate and cerebellar vermis. No significant differences in total brain volume, caudate volume, asymmetry of the hemispheres or asymmetry of the caudate were found between the groups. Measurements of the left and total posterior superior and inferior lobes of the vermis, however, indicated smaller volumes for both pure ADHD and co-morbid children compared to the controls. Analysis of variance demonstrated no significant volumetric differences between the pure ADHD and co-morbid types. Prolonged exposure to methylphenidate was associated with caudate volumes. These results suggest ADHD and ADHD co-morbid with CD have similar deviant cerebellar morphology and replicate previous studies with an epidemiologically derived sample.     

Classes of adolescents with disruptive behaviors in a general population sample

Background To study disruptive behaviors adequately, we need to distinguish between individuals with different types of problems that may have a different etiology. The availability of a taxonomic system that helps in identifying homogeneous groups of individuals, with similar patterns of disruptive behaviors, is crucial to achieve this goal. Therefore, we examine which classes of preadolescents with symptoms of Attention Deficit/Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), and Conduct Disorder (CD) can be identified in the general population. Methods Disruptive behaviors of 2,230 10–12 year olds from the Dutch general population were assessed with the Child Behavior Checklist and Youth Self-Report. Results Latent class analysis revealed three classes of preadolescents: the first characterized by high scores on ADHD, ODD, and CD items; a second by high probabilities of ADHD and ODD symptoms; a third with low scores on all items. Conclusions Because classes of preadolescents with symptoms of only one type of disruptive behavior problems could not be identified, it can be questioned how useful separate diagnostic distinctions are in general population studies.     

Temperament and character and psychopathy in male conduct disordered offenders

Adult male offenders with high psychopathy scores are characterized by high Novelty Seeking, low Harm Avoidance and low Cooperativeness; temperament and character traits that may moderate treatment outcomes. This is the first study to investigate if a similar profile is present in juveniles. One hundred and twenty two incarcerated juvenile male offenders who met the criteria for conduct disorder in the absence of current psychiatric disorder (e.g. psychosis, depression, anxiety) were rated on the Temperament and Character Inventory (TCI) and the Psychopathy Checklist: Youth Version (PCL: YV). PCL: YV total score was positively correlated with Novelty Seeking but negatively correlated with Cooperativeness and Harm Avoidance. Examination of the PCL: YV facets indicated a significant negative correlation between Harm Avoidance and PCL: YV Interpersonal and PCL: YV Antisocial; and Reward Dependence and Cooperativeness and PCL: YV Lifestyle/Behavioral. Relationships were primarily with lifestyle/behavioral and antisocial facets of psychopathy. The TCI profile resembles that seen in adult offenders and has implications for treatment as low cooperativeness and reward dependency are likely to be key responsivity factors that need to be addressed in treatment planning.     

Attention-Deficit/Hyperactivity Disorder and comorbidity in Brazil

Abstract. Objective: The aim of this study was to compare the pattern of comorbidity in referred samples of Attention-Deficit/Hyperactivity Disorder (ADHD) patients from two different geographic areas in Brazil. Methods: The diagnoses of ADHD and comorbid conditions, according to DSM-IV criteria, were achieved in both clinics through semi-structured interview methodology, complemented by clinical interviews with the children or adolescents and their parents. Results: We assessed 343 ADHD children and adolescents in Porto Alegre (capital of the southernmost state of the country) and 78 ADHD youths in Rio de Janeiro (capital of a southestern state). Although a significant difference in the prevalence of ADHD without comorbidity was detected between the two groups (p = 0.02), no significant difference was detected in the profile of comorbidities between them. Main ADHD comorbidities in both samples were: a) Oppositional Defiant Disorder (Porto Alegre = 39.1%; Rio de Janeiro = 51.3 %); b) Anxiety Disorders (Porto Alegre = 24.2%; Rio de Janeiro = 30.8 %); c) Conduct Disorder (Porto Alegre = 13.7%; Rio de Janeiro = 17.9 %); and d) Major Depression and/or Dysthymia (Porto Alegre = 11.4%; Rio de Janeiro = 10.3 %). Conclusions: Our results from clinical samples in a developing country with a diverse culture suggest the crosscultural validity of the ADHD comorbidity profile.     

Anxiety Symptoms in Boys with Autism Spectrum Disorder,Attention-Deficit Hyperactivity Disorder,or Chronic Multiple Tic Disorder and Community Controls

We compared symptoms of generalized anxiety disorder (GAD) and separation anxiety disorder (SAD) in 5 groups of boys with neurobehavioral syndromes: attention-deficit/hyperactivity disorder (ADHD) plus autism spectrum disorder (ASD), ADHD plus chronic multiple tic disorder (CMTD), ASD only, ADHD only, and community Controls. Anxiety symptoms were assessed using parent and teacher versions of a DSM-IV-referenced rating scale. All three groups of boys with co-morbid ADHD evidenced more severe anxiety than Controls. Group differences in anxiety varied as a function of symptom, disorder, informant, and co-morbidity supporting the notion that co-morbid neurobehavioral syndromes differentially impact clinical features of co-occurring anxiety symptoms. Findings also suggest that GAD and SAD are phenomenologically unique, even in children with ASD. Implications for nosology are discussed.     

Neuropsychological Functioning of Adults with Attention Deficit Hyperactivity Disorder

The neuropsychological functioning of adults with Attention Deficit Hyperactivity Disorder (ADHD) was compared to that of healthy controls and individuals with mild psychiatric disorders including attentional complaints. Thirty adults in each group were examined on the Conners' Continuous Performance Test (CPT) and measures of attention, executive function, psychomotor speed, and arithmetic skills. The ADHD group performed lower than healthy controls on most measures. However when compared to the psychiatric group, the performances of the ADHD group were not significantly lower on any of the measures. The predictive power of the tests was poor in discriminating ADHD from psychiatric disorder. Implications for the clinical diagnosis of ADHD are discussed.     

Risk Factors and Youth Recidivism Prediction in General and Property Offenders

The predictive validity of risk factors for recidivism in general offenders is well known, but few studies have considered specific crimes – such as non-violent property offences – in this context. The prediction of risk factors on recidivism among general and property offenders is analysed in an attempt to capture any motivational differences underlying diverse types of crimes. Subsamples of theft and property damage offenders were extracted from a general population of 210 juvenile offenders aged between 14 and 18 years. All participants were assessed using the Spanish version of the Youth Level of Service/Case Management Inventory (YLS/CMI) and their recidivism rates were evaluated in terms of the number of new records in a 24-month follow-up period. Factors pertaining to the Big Four (especially the antisocial peers risk factor) seem to be the most predictive factors for both general offenders and non-violent property offenders; the type of crime does not seem to make a significant difference to youth offenders’ needs.     

Diffusion tensor imaging reveals white matter abnormalities in Attention-Deficit/Hyperactivity Disorder

The specific brain structures or neural mechanisms underlying dysfunction in individuals with Attention-Deficit/Hyperactivity Disorder (ADHD) are not well established, particularly in regard to white matter (WM). Diffusion tensor imaging (DTI) was used to investigate WM in 12 adolescent males diagnosed with ADHD only and 12 typically developing controls (group matched; mean age=15.64 years, SD=1.15). In addition to fractional anisotropy (FA), we also examined axial and radial diffusivity (AD and RD) in an effort to help elucidate conflicting findings suggesting that both lower and higher FA values are characteristic of ADHD. Tract-based spatial statistics and voxel-wide analyses were conducted on the data utilizing a pre-frontal mask to enable focus on fronto-striatal and prefrontal pathways. Adolescents with ADHD had significantly higher FA and AD values in fronto-striatal pathways compared with controls. No differences were observed for RD. These results contribute to the growing literature implicating prefrontal WM variations in neuropsychiatric disorders, and are consistent with findings suggesting a role for fronto-striatal pathways in ADHD pathophysiology.     

Examining relations between psychopathology and psychopathy dimensions among adolescent female and male offenders

Aim  This study was performed to investigate relations between psychopathology and psychopathy in adolescent female and male detainees. Method  We examined 91 male and 123 female adolescent detainees (aged 14–19) for psychopathology -using the Youth Self Report, the Overt Aggression Scale-Modified and a Conduct Disorder Self Report Scale- and for psychopathic dimensions using the psychopathy checklist youth version (PCL:YV). Based on a linear regression analysis we compared the specific associations between psychopathology and psychopathy in both male and female delinquent juveniles. Results  Our results revealed higher scores for externalizing behavior and psychopathic dimensions in delinquent males, and higher internalizing problem scores in delinquent females. Furthermore, we found a positive relationship between suicidal behavior and the psychopathy total score as well as the affective, the lifestyle and the antisocial dimension only in girls. No association was found for suicidal behavior in boys. Regarding anxious-depressive behavior, we found a negative relation to the psychopathy total score and to the affective psychopathy factor for the boys. Conclusion  Expectedly, the population of incarcerated adolescents exhibited a high prevalence of psychopathology. At the same time our results referred to meaningful gender-related differences with respect to associations with psychopathy. The gender-related differences in psychopathological symptoms could indicate varied subtypes of psychopathy in boys and girls.     

Social skills and psychopathic traits in maltreated adolescents

Child maltreatment has frequently been associated with impaired social skills and antisocial features, but there are still controversies about the effect of each type of maltreatment on social behaviour. The aim of this study was to compare the social functioning and psychopathic traits of maltreated adolescents (MTA) with a control group (CG) and to investigate what types of maltreatments and social skills were associated with psychopathic traits in both groups. The types and intensity of maltreatment were evaluated through the Childhood Trauma Questionnaire (CTQ) in 107 adolescents, divided into the MTA group (n = 66) and non-maltreated youths (n = 41), our CG. The Hare Psychopathy Checklist: Youth Version (PCL: YV) and a detailed inventory for evaluation of social skills in adolescents were also applied in all individuals. MTA presented more psychopathic traits than the CG, in all domains measured by PCL: YV, independently of IQ levels and the presence of psychiatric disorders. Interestingly, the groups did not differ significantly from each other on indicators of social skills. Multiple regression analysis revealed that emotional neglect was the only maltreatment subtype significantly associated with psychopathic traits, more specifically with the PCL: YV interpersonal factor (F1), and that some social skills (empathy, self-control and social confidence) were related to specific psychopathic factors. The results highlight that emotional neglect may be more detrimental to social behaviours than physical and sexual abuse, and that neglected children require more specific and careful attention.     

Violent persons with schizophrenia and comorbid disorders: a functional magnetic resonance imaging study

The main goal of this functional Magnetic Resonance Imaging (fMRI) study was to verify the hypothesis that seriously violent persons with Sz and the co-morbid diagnoses of an Antisocial Personality Disorder (APD) and a Substance Use Disorder (Sz+APD+SUD) would present a different pattern of prefrontal functioning than seriously violent persons with Sz only. In support with the main hypothesis, frontal basal cortices were significantly less activated in persons with Sz+APD+SUD during the execution of a go/no-go task than in persons with Sz only and non-violent persons without a mental illness. In contrast, significantly higher activations in frontal motor, premotor and anterior cingulate regions were observed in the Sz+APD+SUD group than in the Sz-only group.     

Brief Report: Prevalence of Attention Deficit/Hyperactivity Disorder Among Individuals with an Autism Spectrum Disorder

Currently, both the DSM-IV-TR and ICD-10 preclude the diagnosis of Attention Deficit/Hyperactivity Disorder (ADHD) in cases that present with an Autism Spectrum Disorder (ASD). This criterion will be removed in the upcoming DSM-V, but the relationship between ASD and ADHD, and in particular the prevalence of ADHD among the ASD population, remains controversial. Previous studies have reported clinically significant ADHD symptoms in one-third to three-quarters of ASD-affected individuals (probands). In our sample of 1,838 simplex children and adolescents with ASD, we found that less than 16 % met clinically significant levels of ADHD symptoms, per parent report. When both parent and teacher reports were considered, the comorbidity rate was even lower, at 2 %.     

Attention-deficit/hyperactivity disorder and learning disabilities in adults

Attention-Deficit/Hyperactivity Disorder (ADHD) is a developmental disorder which begins in childhood. It is now recognized that ADHD persists into adolescence and adulthood in the majority of cases. Significant psychiatric comorbidity, particularly substance abuse, antisocial personality disorder, and mood and anxiety disorders occurs in adolescent and adult ADHD. Perhaps one fifth of childhood cases of ADHD may also have co-morbid learning disorder. Significant legal, academic, social, and occupational problems have been observed in adults with ADHD. The clinician faces a diagnostic and treatment challenge in trying to determine whether ADHD and learning disabilities (LDs) are present in the adult patient. Treatment and recommendations for accommodations in institutions of higher education and the workplace may rest on accurate discrimination between ADHD and LD.     

Examining the relationship between Attention-Deficit/Hyperactivity Disorder and overweight in children and adolescents

Although a higher prevalence of overweight/obesity was reported in clinical samples of patients with Attention-Deficit/Hyperactivity Disorder (ADHD), an association between overweight and ADHD has yet not been established in the general population in childhood. As both disorders are common and significantly affect psychosocial functioning, we investigated the prevalence of ADHD in overweight/obese youth and vice versa. In a cross-sectional nationally representative and community based survey 2,863 parents and their children aged 11–17 years rated symptoms on the Diagnostic and Statistical Manual of Mental Disorders-based German ADHD Rating scale. Weight and height were assessed by professionals. Body mass index was categorized according to national age and sex specific reference values. Overall, 4.2% of the respondents met criteria for ADHD. The prevalence of ADHD was significantly higher for overweight/obese (7%) than for normal weight (3.5%) and underweight (4.9%) children. In a logistic regression analysis controlling for age, gender, and socio-economic status, overweight/obese children were twice as likely to have an ADHD diagnosis (OR = 2.0). Vice versa, adjusting for all covariates, children with ADHD had an OR of 1.9 for overweight/obesity status. For all weight-status groups, children with ADHD more frequently reported eating problems as compared to their non-clinical counterparts. Overweight/obese respondents with ADHD displayed the highest level of health services utilization. A clinician should be aware of the significant risk for a child with ADHD to become overweight and for an overweight child to have ADHD. Longitudinal studies are needed to better understand the mechanisms underlying the association between ADHD and overweight/obesity.     

Two dopamine genes related to reports of childhood retrospective inattention and conduct disorder symptoms.

The 7-repeat allele of the dopamine receptor D4 gene (DRD4) and the 10 repeat allele of the dopamine transporter gene (DAT1) have shown association and linkage with symptoms of attention deficit hyperactivity disorder (ADHD) in childhood. The parents of ADHD children (clinic group, n = 80 fathers and 107 mothers) and control children (control group, n = 42 fathers and 51 mothers) were the focus of this study. These parents reported retrospectively on their level of ADHD Inattention and Conduct Disorder symptoms in adolescence. In analyses of the relation of symptom levels to the DRD4 and DAT1 genotypes, fathers possessing the 7 repeat DRD4 allele had greater levels of both inattention and conduct disorder symptoms. Mothers with the 10/10 genotype had higher levels of inattention symptoms. Thus, genetic associations found in children may be replicable in their parents.     

Medium-term Outcome of Children Given Stimulants for Attention Deficit Hyperactivity Disorder

Many studies have demonstrated the short-term efficacy of stimulant drugs in decreasing the symptoms of Attention Deficit Hyperactivity Disorder (ADHD). However, long-term studies have not shown a similar effect. In this study, we report an audit of the medium-term outcome of 50 children with ADHD referred to a mental health service and treated with stimulants for at least 6 months. A poor outcome group was identified consisting of 30% of the children. As a group, they received a significantly higher dose of stimulant. More studies, with prospective design, are required to examine the medium-term outcome of children with ADHD on medication.     

The structure of DSM-IV ADHD, ODD, and CD criteria in adolescent boys: a hierarchical approach

Numerous studies have examined the structure of the childhood externalizing disorder symptoms of Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), and Conduct Disorder (CD), both separately as well as simultaneously. The present study expanded on previous findings by implementing a multi-level hierarchical approach to investigating the component structure of ADHD, ODD, and CD criteria in 487 14-year-old boys from the Minnesota Twin Family Study (MTFS). We found support for a hierarchical conceptualization of externalizing behavior criteria in early adolescent boys by specifying how one-, two-, three-, four-, five- and six-factor models of externalizing criteria can be integrated. These results suggest that it may be more beneficial to conceptualize different levels of this hierarchy as relevant to different issues in case conceptualization and research design, from the broad level of an overall externalizing spectrum, to the level of finer-grained subtypes within specific disorders.