The Nature of Executive Function (EF) Deficits in Daily Life Activities in Adults with ADHD and Their Relationship to Performance on EF Tests

Although attention-deficit/hyperactivity disorder (ADHD) is believed to impair EF, research using EF tests shows such deficits exist in only a minority of those with ADHD. This study hypothesized that this disparity is largely due to the low ecological validity of these EF tests. A 91-item rating scale of EF was constructed based on EF theories and found to represent 5 underlying dimensions: Self-Management to Time, Self-Organization/Problem-Solving, Self-Discipline, Self-Motivation, and Self-Activation/Concentration. Three groups were compared on these scales: Adults with ADHD (N = 146), Clinical control adults not diagnosed with ADHD (N = 97), and a Community control group (N = 109). The ADHD group had more severe EF ratings than did the Clinical group and Community control groups on all 5 scales using both self and other-reported versions. Relationships between the EF scales and tests were low and mostly not significant. Most ADHD adults were clinically impaired on the EF ratings but only a small minority were so on the tests. The EF ratings were more highly associated with measures of deviant behavior (antisocial acts, crime diversity, negative driving outcomes) than the EF tests, most of which were unrelated to such behavior. These results agree with previous research showing that EF tests are largely unrelated to EF ratings and that EF ratings are more strongly associated with impairment in major life activities, in this case deviant or antisocial behavior. Contrary to earlier conclusions based on EF tests, adult ADHD involves substantial problems in EF in daily life.     

Adolescent Disruptive Behavior and Borderline Personality Disorder Symptoms in Young Adult Men

Very few studies have prospective information, especially regarding males, on the prediction of Borderline Personality Disorder (BPD) in adulthood from psychiatric disorders in childhood. Certain childhood disorders, however, have notably similar features in common with BPD. In particular, the affective dysfunction, hostility and interpersonal conflict of Oppositional Defiant Disorder (ODD) and the impulsivity of Attention Deficit Hyperactivity Disorder (ADHD) in particular may be indicative of an early developmental path towards BPD. The present study uses longitudinal data from a clinical sample of 177 boys, initially between the ages of 7 and 12, who were followed up annually to age 18, and who were reassessed at age 24 (n = 142). The study examines the prediction from repeated childhood measures of psychopathology measured annually through adolescence to BPD symptoms assessed at age 24, accounting for the effects of covariates including substance use, other personality disorders at age 24 and harsh physical punishment. The prevalence of BPD in this sample was consistent with other population estimates. Attention Deficit Hyperactivity Disorder (ADHD) and ODD were the only child psychiatric disorders to predict BPD symptoms, and the oppositional behavioral dimension of ODD was particularly predictive of BPD. These results indicate possible developmental links between early psychiatric disorders and BPD.     

Self-Reported Psychopathic Traits in Children: Their Stability and Concurrent and Prospective Association with Conduct Problems and Aggression

The current study investigated the 18-month stability of self-reported psychopathic traits measured through the Youth Psychopathic traits Inventory–Child Version (YPI-CV) and their concurrent and prospective associations with conduct problems and aggression in a sample of 9–12 year olds (n = 159, 52% boys) from the community. Self-reported psychopathy scores were moderately to highly stable and traits were positively related to conduct problems both concurrently and at follow-up, the latter even after controlling for initial levels of conduct problems. Higher self-reported psychopathic traits were also related to higher reactive, but particularly proactive aggression at follow-up. Finally, children with persistently high levels of psychopathic traits exhibited higher levels of conduct problems and proactive aggression at follow-up than those with unstable or stable low psychopathic traits.     

Developmental Pathways to Conduct Problems: A Further Test of the Childhood and Adolescent-Onset Distinction

This study tested several theoretically important differences between youth with a childhood-onset and youth with an adolescent-onset to their severe conduct problems. Seventy-eight pre-adjudicated adolescent boys (ranging in age from 11 to 18) housed in two short-term detention facilities and one outpatient program for youth at risk for involvement in the juvenile justice system participated in the current study. The sample was divided into those with a childhood-onset to their serious conduct problem behavior (n = 47) and those with an adolescent-onset (n = 31). The childhood-onset group showed greater levels of dysfunctional parenting, callous–unemotional traits, and affiliation with delinquent peers. The only variable more strongly associated with the adolescent-onset group was lower scores on a measure of traditionalism.     

Timing of Onset and Correlates of Severe Conduct Problems in Adjudicated Girls and Boys

An influential model for explaining the development of conduct disorder (CD) in boys proposed that there are two distinct trajectories through which boys develop CD that differ on the timing of onset, correlates, and outcome. In this study, the applicability of this two trajectory approach to the development of CD in girls was tested. Participants were 72 adolescents (mean = 15.17 years of age; SD = 1.32) who were adjudicated for serious patterns of illegal behavior in a secure detention facility, nearly all of whom (94.4%) met criteria for a diagnosis of CD. Based on a combination of youth self-report and file review, boys in the sample were fairly evenly split between a childhood-onset to their CD symptoms and an adolescent-onset to their symptoms. In contrast, girls more uniformly exhibited an adolescent-onset to their severe antisocial behavior. Despite this later age of onset, the antisocial girls tended to resemble the childhood-onset boys on personality traits such as showing problems of impulse control and showing combination of both a callous and unemotional interpersonal style and poor impulse control. These findings suggest modifications of or alternatives to the two-trajectory model may be needed to explain the development of CD in girls.     

Psychopathie,antisoziale Persönlichkeitsstörung und Sexualdelinquenz

In today’s field of forensic psychiatry, psychopathy is seen as a subtype of antisocial personality disorder and includes manipulative behavior, egocentric and arrogant characteristics, high-risk behavior as well as a lack of empathy. Empirical data on the prevalence of psychopathy and antisocial personality disorder among offenders greatly vary depending on the study design and the composition of the sampled population. Offenders who committed both violent and sex offenses seem to have antisocial traits with a higher probability than offenders who committed only violent or only sex offenses. In the context of criminal responsibility and risk assessment for sex offenders, antisocial and psychopathic traits have a negative impact on the prediction of recidivism. Many study results, even though not all, additionally indicate that the combination of psychopathic traits and sexual deviance (i.?e. for example a paraphilic disorder such as sexual sadism) in sex offenders may be associated with a particularly high risk to reoffend. Due to the specific interpersonal characteristics (e.?g., dominant, provocative behavior, exaggerated self-esteem), therapeutic treatment of sex offenders with antisocial and psychopathic traits is often difficult. The regular supervision by the therapist is considered to be crucial to avoid harmful relationship dynamics or distorted perception of the therapist.     

Peer-Nominated Deviant Talk Within Residential Treatment: Individual and Group Influences on Treatment Response

This research examined deviant talk during summer residential treatment using peer nominations and extensive field observations. Participants were 239 youth (M _age = 12.62, SD = 2.60; 67% male), nested in 26 treatment groups. Deviant talk was present in this setting, showed individual differences, and increased over time, especially for younger boys. As expected, its relationship to treatment response was moderated by peer behavior. Initial levels of individual deviant talk were related to clinical improvement, but primarily when peer deviant talk was low. Initial levels of peer deviant talk were related to higher than expected end of treatment aggression, especially for youth who were high in deviant talk. Deviant talk effects were observed for staff impressions of change and observations of aggression and adjustment. Initial antisocial behavior affected whether individual or peer levels of deviant talk more heavily influenced treatment response. Implications for clinical assessment and treatment monitoring are discussed.     

The Role of Temperament and Personality in Problem Behaviors of Children with ADHD

This study describes temperament, personality, and problem behaviors in children with Attention-Deficit Hyperactivity Disorder (ADHD) aged 6 to 14 years. It targets differences between an ADHD sample (N = 54; 43 boys) and a large community sample (N = 465; 393 boys) in means and variances, psychometric properties, and covariation between traits and internalizing and externalizing problems. Parents rated their children on Buss and Plomin’s and Rothbart’s temperament models, a child-oriented five-factor personality model and also on problem behavior. Relative to the comparison group, children with ADHD presented with a distinct trait profile exhibiting lower means on Effortful Control, Conscientiousness, Benevolence and Emotional Stability, higher means on Emotionality, Activity, and Negative Affect, but similar levels of Surgency, Shyness, and Extraversion. Striking similarities in variances, reliabilities and, in particular, of the covariation between trait and maladjustment variables corroborate the spectrum hypothesis and suggest that comparable processes regulate problem behavior in children with and without ADHD.     

Executive Functions in Preschool Children with Aggressive Behavior: Impairments in Inhibitory Control

The question whether executive function (EF) deficits in children are associated with conduct problems remains controversial. Although the origins of aggressive behavior are to be found in early childhood, findings from EF studies in preschool children with aggressive behavior are inconsistent. The current study aimed to investigate whether preschool children with aggressive behavior show impairments in EF. From a population-based sample, 82 preschool children who were showing aggressive behavior as indicated by scores at or above the 93rd percentile on the Aggressive Behavior Scale of the CBCL 1 1/2-5 were selected. These children with aggressive behavior were matched on IQ to a group of typically developing control children (N = 99). Six neuropsychological tasks were administered to assess set shifting, inhibition, working memory and verbal fluency. A factor analysis was conducted which yielded one clear factor: inhibition. Aggressive preschool children showed poorer performance on this inhibition factor than control children and boys performed worse on this factor than girls. This association between aggressive behavior and inhibition deficits was maintained after controlling for attention problems. In addition, gender differences in all EFs measured were found with boys exhibiting more impairment in EF than girls. These findings demonstrate that preschool children with aggressive behavior show impairments in inhibition, irrespective of attention problems.     

Neighborhood Disadvantage, Parent–Child Conflict, Neighborhood Peer Relationships, and Early Antisocial Behavior Problem Trajectories

  This study examined relations among neighborhood disadvantage, parent–child conflict, deviant peer involvement in the neighborhood, and early-starting antisocial trajectories. Antisocial group patterns were identified in 218 low-income boys followed from ages 5 to 11, and neighborhood and family variables were evaluated as predictors in early and middle childhood. Four trajectory groups emerged: one increasing pattern that corresponded with developmental theories of early-starting antisocial behavior; one with initially high and decreasing problems over time; and two low antisocial groups. Parent–child conflict and neighborhood disadvantage were significantly associated with trajectory patterns, with youth in the 2 higher antisocial behavior groups characterized by more neighborhood problems and parent–child conflict than other groups. The results suggest that in early childhood, neighborhood disadvantage and family conflict place children at risk for early-starting trajectories, and that involvement with deviant peers in the neighborhood takes on an increasingly important role in patterns of antisocial behavior over middle childhood.     

Childhood Predictors of Desistance and Level of Persistence in Offending in Early Onset Offenders

Childhood predictors of adolescent offending careers were studied in 310 boys from the longitudinal Pittsburgh Youth Study who started offending prior to age 12. Three main groups were distinguished: serious persisters (n = 95), moderately serious persisters (n = 117), desisters (n = 63), and an intermittent group (n = 35). Group membership was predicted using risk and promotive factors measured in childhood. Serious and moderately serious persisters could be distinguished well from desisters (29.2% and 32.3% explained variance). Distinction between the two persister groups proved somewhat more difficult (20.9% explained variance). More serious persisters than desisters showed disruptive behavior, while moderately serious persisters fell in between. Further, more moderately serious persisters were marked by social disadvantage. Family involvement, small family and positive peer relationships were promotive of desistance. Concluding, early onset offenders show considerable heterogeneity in their adolescent offending careers which seem to some extent to be predicted by different sets of risk and promotive factors.     

Gender Differences in Psychopathic Traits,Types, and Correlates of Aggression Among Adjudicated Youth

The current study investigated gender differences in types and correlates of aggression among 150 adjudicated youth (M age = 15.2, SD = 1.4). In cluster analysis, consistent with past studies, one aggressive group characterized by moderate levels of reactive aggression and one characterized by high levels of proactive and reactive aggression emerged and these patterns were consistent across gender. For both boys and girls, the combined proactive/reactive aggression cluster showed the greatest levels of aggression, impulsivity, and callous-unemotional traits, supporting a severity over a typology model of proactive and reactive aggression. Girls displayed significantly higher rates of physical and relational aggression than boys. Girls were highly aggressive toward both girls and boys, whereas boys were highly aggressive only toward other boys. Girls also showed multiple indications of severity and emotionality, indexed by higher rates of negative affect, anxiety, distress about social provocations, and empathy.     

Childhood abuse as a risk factor for suicidal behavior in borderline personality disorder

A childhood history of sexual or physical abuse is highly prevalent in borderline personality disorder (BPD) and is associated with self-destructive behavior in clinical and nonclinical samples. Viewing BPD as a "high risk" disorder, we asked if childhood abuse was a risk factor for adult suicidal behavior or if it was related to other known risk factors for suicide in BPD. A semistructured Abuse History was obtained in 61 criteria-defined BPD patients, who were characterized by structured interviews and self-reports for Axis I disorders, Suicide History, BPD severity, hopelessness, impulsivity, impulsive-aggression, and antisocial traits. Occurrence and severity of childhood sexual abuse, but not physical abuse, predicted adult suicidal behavior independent of other known risk factors. The odds of a sexually abused patient attempting suicide in adulthood was over 10 times that of a patient who was never sexually abused. Given a history of childhood sexual abuse, the risk of adult suicidal behavior in BPD was increased by antisocial traits, severity of BPD, hopelessness, or comorbid major depressive episode (MDE).     

Differential Item Functioning on Antisocial Behavior Scale Items for Adolescents and Young Adults from Single-Parent and Two-Parent Families

We investigated measurement equivalence in two antisocial behavior scales (i.e., one scale for adolescents and a second scale for young adults) by examining differential item functioning (DIF) for respondents from single-parent (n = 109) and two-parent families (n = 447). Even though one item in the scale for adolescents and two items in the scale for young adults showed significant DIF, the two scales exhibited non-significant differential test functioning (DTF). Both uniform and nonuniform DIF were investigated and examples of each type were identified. Specifically, uniform DIF was exhibited in the adolescent scale whereas nonuniform DIF was shown in the young adult scale. Implications of DIF results for assessment of antisocial behavior, along with strengths and limitations of the study, are discussed.     

Associations Between Symptoms of Borderline Personality Disorder,Externalizing Disorders,and Suicide-Related Behaviors

Borderline personality disorder and externalizing disorders are associated with suicide-related behaviors. The present study examined whether symptoms of borderline personality disorder mediate the relationship between externalizing disorders and suicide-related behaviors. Diagnostic interviews were administered to 344 participants (n = 233 women). Results indicated that symptoms of antisocial personality disorder, alcohol use disorders, and drug use disorders each were significantly associated with suicide threats and self-injurious behavior in women and symptoms of antisocial personality disorder were associated with suicide attempts in women. With the exception of the association between symptoms of alcohol dependence and self-injurious behaviors, borderline personality disorder symptoms mediated or partially mediated all associations between externalizing disorders and suicide-related behaviors in women. These results highlight the importance of assessment and treatment of borderline personality disorder symptoms in individuals with externalizing disorders, particularly in the presence of suicide-related behaviors.

Exploring differences in youth and parent reports of antisociality among adolescent sexual and nonsexual offenders

This study examined the extent of, and explored several possible explanations for, the discrepancies found between adolescent and parent reports of conduct problems in adolescent sexual and nonsexual offenders. We found that adolescent sexual offenders scored lower on measures of conduct problems than did nonsexual offenders, whether on the basis of adolescent or parent report, though the difference was much larger for parent reports. Examining this discrepancy more closely, we found that parents of sexual offenders reported less antisocial behavior than did their sons, whereas parents of nonsexual offenders reported more antisocial behavior than did their sons. The same pattern of results was obtained for reports on impulsivity, but much less so with respect to antisocial personality traits such as narcissism and callousness. Measures of family functioning were generally not related to these parent-adolescent discrepancies in reports of conduct problems, but these discrepancies were positively correlated with parental reports of stress. The implications of these findings for the interpretation of research on adolescent sexual offenders and comparisons of sexual and nonsexual offenders are discussed.     

Violent offenses associated with co‐occurring substance use and mental health problems: Evidence from CJDATS

The present study examines the relationship between substance use, mental health problems, and violence in a sample of offenders released from prison and referred to substance abuse treatment programs. Data from 34 sites (n = 1,349) in a federally funded cooperative, the Criminal Justice Drug Abuse Treatment Studies (CJDATS), were analyzed. Among parolees referred to substance abuse treatment, self‐reports for the six‐month period before the arrest resulting in their incarceration revealed frequent problems with both substance use and mental health. For most offenders with substance use problems, the quantity of alcohol consumed and the frequency of drug use were associated with a greater probability of self‐reported violence. Mental health problems were not indicative of increases in violent behavior, with the exception of antisocial personality problems, which were associated with violence. The paper emphasizes the importance of providing substance abuse treatment in relation to violent behavior among offenders with mental health problems being discharged to the community. Copyright © 2009 John Wiley & Sons, Ltd.     

Suicidal behavior in borderline personality disorder: prevalence, risk factors, prediction, and prevention

Suicidal behavior is frequent in patients with borderline personality disorder (BPD); at least three-quarters of these patients attempt suicide and approximately 10% eventually complete suicide. Borderline patients at greatest risk for suicidal behavior include those with prior attempts, comorbid major depressive disorder, or a substance use disorder. Comorbidity with major depression serves to increase both the number and seriousness of the suicide attempts. Hopelessness and impulsivity independently increase the risk of suicidal behavior, as does a turbulent early life and the presence of antisocial traits. In summary, because BPD is frequently complicated by suicidal behavior, clinicians must avoid the mistake of thinking that a pattern of repeated attempts indicates little desire to die. Clinicians have an important role in preventing suicide attempts and completed suicides by understanding the risk factors.     

Temperament and Problematic Alcohol Use in Adolescence: an Examination of Drinking Motives as Mediators

The present study investigated the associations between temperamental reactivity, drinking motives, alcohol consumption and alcohol-related consequences. Furthermore, it investigated whether drinking motives mediate the relations between temperamental reactivity and the alcohol use variables. The sample consisted of 188 adolescents (64.9% boys) between the ages of 13–20 years (M _age  = 16.9, SD = 1.32). Results revealed that the temperament factors of high BAS fun seeking and high negative affectivity were related to alcohol consumption and alcohol-related consequences respectively. Furthermore, high social and enhancement motives and low conformity motives were associated with alcohol consumption, whereas high coping-depression motives were associated with alcohol-related consequences. Finally, the relation between BAS fun seeking and alcohol consumption was mediated by enhancement and social motives and the association between negative affectivity and alcohol-related consequences was mediated by coping-depression motives. These results highlight the importance of focusing on temperament profiles and their associated drinking motives in the prevention and intervention of alcohol use problems among adolescents.