Life Stress and Suicide in Adolescents Abstract Stress exposure is central to theories of suicide. To advance understanding of the relation between stress and suicide, we examined whether specific, theoretically-pertinent life stressors were differentially related to suicidal thinking versus suicidal behaviors among hospitalized adolescents. Participants were 197 (144 female) adolescents aged 13 to 19 years old (M = 15.61, SD = 1.48) recruited from an acute residential psychiatric treatment program. Participants were categorized into mutually exclusive groups: psychiatric controls (n = 38) with no lifetime history of suicide ideation or suicide attempts, suicide ideators (n = 99) with current ideation and no lifetime attempts, and suicide attempters (n = 60) with a lifetime history of suicide ideation and at least one attempt in the past month. Adolescents completed the Stress and Adversity Inventory for Adolescents (Adolescent STRAIN), which assessed life events and chronic difficulties occurring in five social-psychological categories: Interpersonal Loss, Physical Danger, Humiliation, Entrapment, and Role Change/Disruption. Additionally, they completed a structured interview and symptom questionnaires to capture concurrent psychopathology. Controlling for demographic and clinical covariates, only Interpersonal Loss events distinguished attempters from psychiatric controls (OR = 2.27) and ideators (OR = 1.49); no events or difficulties differentiated ideators from controls. These effects persisted when analyses were restricted to single attempters and when events following the most recent attempt were excluded. The findings elucidate potential social-environmental triggers of suicide. Ultimately, this may improve the identification of ideators most likely to make an attempt, enabling the deployment of targeted early interventions.

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

Emotional Underarousal and Overarousal and Engagement in Relational Aggression: Interactions between Relational Victimization, Physiological Reactivity, and Emotional Sensitivity Abstract The present study examined if overarousal (i.e., dysregulation and high emotional sensitivity) and underarousal (i.e., fearlessness and emotional insensitivity) to peer stress, reflected in physiological reactivity and subjective emotional sensitivity, exacerbated risk for relational aggression in relationally victimized children. Participants were a community sample of 125 children (10–12 years, M = 11.34 years, SD = 0.89; 45% female). Teachers provided ratings of children’s relational victimization and relational aggression. Children’s physiological reactivity was assessed based on skin conductance level (SCL) reactivity and respiratory sinus arrhythmia (RSA) reactivity to a standardized peer rejection task. Children’s subjective emotional sensitivity was assessed using self-reported ratings of distress to hypothetical relational provocation vignettes. Results indicated that relational victimization was significantly associated with relational aggression only for children with high SCL reactivity and high emotional sensitivity (i.e., physiological and subjective overarousal) and for children with low SCL reactivity and low emotional sensitivity (i.e., physiological and subjective underarousal); relational victimization did not predict relational aggression among children with high SCL reactivity but low emotional sensitivity or among children with low SCL reactivity but high emotional sensitivity. Relational victimization was also marginally more strongly associated with relational aggression for children displaying RSA augmentation. Results suggest emotional overarousal and underarousal may both serve as vulnerabilities for relational aggression among relationally victimized youth, and underscore the importance of including physiological and subjective indices of emotional reactivity in studies of aggression. Implications for theory and intervention are discussed.

Network Analysis of ADHD and ODD Symptoms: Novel Insights or Redundant Findings with the Latent Variable Model? Abstract A latent variable model (LVM) and network analysis (NA) were applied to mother and father ratings of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptoms to determine if NA offers unique insights relative to the LVM. ADHD-inattention (IN), ADHD-hyperactivity/impulsivity (HI), and ODD symptoms along with academic competence behaviors (reading, arithmetic, and writing skills) were rated by mothers and fathers of Brazilian (n = 894), Thai (n = 2075), and United States (n = 817) children (Mage = 9.04, SD = 2.12, 49.5% females). LVM indicated that (1) the ADHD-IN, ADHD-HI, and ODD three-factor model yielded a close global-fit with no localized ill-fit; (2) nearly all loadings were substantial; (3) like-symptom loadings, like-symptom thresholds, and like-factor means showed invariance across mothers and fathers; (4) the three factors showed convergent and discriminant validity across mothers and fathers; and (5) only the ADHD-IN showed a unique negative relationship with academic competence. NA indicated that (1) a walktrap community analysis resulted in ADHD-IN, ADHD-HI, and ODD symptom communities; (2) the three symptom communities were consistent across mothers and fathers; (3) only three ADHD-IN symptoms showed unique relationships with the three academic competence items. NA has proven useful for numerous mental disorders. In the current study, NA results were mostly congruent with the LVM model, with a few notable exceptions. The results are discussed in the context of model assumptions and application considerations in the context of ADHD/ODD symptoms relative to other symptom dimensions.

The Developmental Propensity Model Extends to Oppositional Defiant Disorder: a Twin Study Abstract Previous research has supported the developmental propensity model, which proposes that three socioemotional dispositions (prosociality, negative emotionality, and daring) increase risk for the development of conduct problems through shared genetic and environmental influences. The current study extends this research by examining the model in relation to oppositional defiant disorder (ODD). Based on a confirmatory factor analysis, ODD was examined as three separate dimensions (irritable, headstrong, and hurtful) rather than a unitary construct. Parents of 686 same-sex twins (ages 7–13) provided ratings of their twins’ dispositions and ODD symptoms. Results from a path model examining phenotypic relationships showed that all dispositions were significantly related to each ODD dimension, except daring was not predictive of the irritable dimension. Preliminary twin analyses showed nonadditive genetic effects only on daring, which limited the appropriateness of evaluating it with the other dispositions. Results from a series of models used to examine etiological associations showed all ODD dimensions had common additive genetic influences with prosociality and negative emotionality. Only headstrong had common additive genetic influences with daring. Irritable and headstrong had common shared environmental influences with respect for rules (an aspect of prosociality), and common nonshared environmental influences with negative emotionality. Hurtful showed no shared environmental influences, but it had common nonshared environmental influences with prosociality and negative emotionality. These findings support the idea that the socioemotional dispositions in the developmental propensity model have some common etiological influences with ODD dimensions, suggesting this model can provide a novel framework for understanding the development of ODD.

Disinhibited Social Engagement Disorder in Early Childhood Predicts Reduced Competence in Early Adolescence Abstract Psychosocial deprivation is associated with the development of socially aberrant behaviors, including signs of disinhibited social engagement disorder (DSED). In longitudinal studies, signs of DSED have been shown to decrease over time, especially as children are removed from conditions of deprivation. What is less clear is whether signs of DSED in early childhood are associated with poorer functioning in early adolescence, including among children who no longer manifest signs of DSED at this age. In a sample of 136 Romanian children from the Bucharest Early Intervention Project (BEIP), who were exposed to early psychosocial deprivation in the form of institutional care, we examined caregiver-reported (ages 30, 42, and 54 months and 12 years) and observer-rated (age 54 months) signs of DSED. Competent functioning in early adolescence (age 12 years) was assessed across seven domains (i.e., family relationships, peer relationships, academic performance, physical health, mental health, substance use, and risk-taking behavior). A diagnosis of DSED in early childhood was associated with reduced competence in early adolescence. Furthermore, this association was significant even when signs of DSED diminished by age 12 years. We conclude that signs of DSED in early life are associated with reduced likelihood of competent functioning many years later in adolescence, even if signs of the disorder remit.

Suicide Attempts and Course of Suicidal Ideation among Puerto Rican Early Adolescents Abstract Suicidal behavior increases substantially during early adolescence, a critical understudied developmental period. This study reports on the prevalence of suicidal ideation, suicide attempts, and course of suicidal ideation among Puerto Rican early adolescents, a high-risk group for suicidal behavior in adulthood. Gender differences and the prospective association of psychiatric disorders with course of suicidal ideation are examined. Participants were 1228 Puerto Rican adolescents (ages 10–13 at wave 1; 48% female) and parents, selected through probability-based sampling, assessed yearly across three waves. Adolescents and parents reported via Diagnostic Interview Schedule for Children-IV about 12-month suicide attempts and suicidal ideation (further categorized as never present, onset, recurrence, and remission), mood and anxiety disorders; parents reported on disruptive disorders. Over the three waves, 9.5% early adolescents thought about suicide and 2.1% attempted suicide. In adjusted multinomial regression models, compared to those with never present suicidal ideation, female gender was related to onset of suicidal ideation (OR = 2.60; 95% CI, 1.22–5.55). Disruptive disorders were related to onset (OR = 5.80; 95% CI, 2.06–16.32) and recurrence of suicidal ideation (OR = 5.07, 95% CI, 1.14–22.47), mood disorders were related to remission (OR = 14.42, 95% CI, 3.90–53.23), and anxiety disorders to onset of suicidal ideation (OR = 3.68, 95% CI, 1.75–7.73). Our findings inform strategies tailored for early adolescents. To address onset of suicidal ideation, prevention should focus on girls and those with anxiety or disruptive disorders. When ideation is recurrent, interventions oriented to reduce disruptive behavior and its consequences may help achieve remission.

Negative Parenting Moderates the Prospective Association of ADHD Symptoms and Youth Social Problems Abstract Although ADHD and negative parenting are established predictors of youth outcomes, their independent and interactive effects on youth social functioning remain unclear. We tested childhood ADHD symptoms and negative parenting as independent and interactive predictors of prospective change in social problems across a four-year follow-up. At baseline, families of 221 (33% female) children with (n = 94) and without ADHD were rigorously assessed including observed positive and negative parenting behavior, youth ADHD symptoms, as well as multi-informant ratings of youth social problems at multiple occasions. Based on multiple regression with robust standard errors and full-information maximum likelihood procedures to address missing data, ADHD symptoms positively predicted social problems, even with control of observed parenting behavior, child age and sex, oppositional defiant disorder symptoms, and baseline social problems. Additionally, a child ADHD symptoms x negative parenting interaction uniquely predicted separate parent- and teacher-rated social problems where ADHD symptoms positively predicted social problems exclusively in the context of high (+1SD) and very high (+2 SD) negative parenting, respectively. When ADHD was separated into distinct dimensions (i.e., inattention, hyperactivity), an interaction between inattention symptoms and negative parenting approached significance such that inattention symptoms positively predicted parent-rated social problems in the context of high negative parenting. We discuss the interaction between parenting and ADHD symptoms in predictions of youth social problems and implications for intervention.

Callous-Unemotional Traits and Academic Performance in Secondary School Students: Examining the Moderating Effect of Gender Abstract Callous-unemotional (CU) traits and male gender are both known risk factors for poor academic outcomes in children and adolescents. However, despite gender differences in CU trait severity, comorbid difficulties and correlates of CU traits, research has yet to examine whether the CU traits and male gender may work together to increase risk for poor academic performance. That is, whether boys high in CU traits perform more poorly across academic disciplines than girls high in these traits. This study therefore aimed to investigate i) the relationships between CU traits, student gender and English, Science and Math grades, and ii) whether gender moderates the association between CU traits and academic outcomes. Participants were 437 children aged 11 to 14 years (mean age 12.50 years; 49% girls; 85% White) attending a state secondary school in England. Students reported on CU traits and externalizing problems and their English, Math and Science grades were gathered from school records. Using hierarchical linear modelling, CU traits were found to be significantly related to lower English, Math and Science grades when controlling for age, gender, sociodemographic disadvantage and externalizing problems. CU traits were significantly related to lower Science grades for boys but not girls. However, gender did not moderate the association between CU traits for English or Math grades. Findings enhance our understanding of how child characteristics may interact to increase the likelihood of poor school outcomes, and therefore help us to identify youth at-risk for poor academic performance.

Parent-Youth Divergence (and Convergence) in Reports of Youth Internalizing Problems in Psychiatric Inpatient Care Abstract When compared to one another, multiple informants’ reports of adolescent internalizing problems often reveal low convergence. This creates challenges in the delivery of clinical services, particularly for severe outcomes linked to internalizing problems, namely suicidal thoughts and behaviors. Clinicians would benefit from methods that facilitate interpretation of multi-informant reports, particularly in inpatient settings typified by high-cost care and high-stakes decision-making. 765 adolescent inpatients (70.3% female; Mage = 14.7) and their parents completed measures of adolescent internalizing problems. We obtained baseline clinical and treatment characteristics from electronic medical records. Latent class analysis revealed four reporting patterns: Parent-Adolescent Low (LL; 49.0%), Parent Low-Adolescent High (PL-AH; 11.5%), Parent High-Adolescent Low (PH-AL; 21.8%), Parent-Adolescent High (HH; 17.6%). Relative to the LL class, adolescents in the PH-AL and PL-AH classes were more likely to be admitted with suicidality. In terms of treatment characteristics and relative to the LL class, HH and PH-AL adolescents were more likely to receive standing antipsychotics, PH-AL adolescents were more likely to be in seclusion, and HH adolescents had longer hospital stays. At discharge and relative to the LL class, HH, PH-AL, and PL-AH adolescents were more likely to receive an anxiety disorder diagnosis. Further, HH, PH-AL, and PL-AH adolescents were more likely to receive partial hospitalization or care in another restrictive environment after inpatient treatment, relative to the LL class. This naturalistic study informs clinical decision-making by aiding our understanding of how multi-informant reports facilitate interpretations of adolescents’ clinical presentations as well as predictions about treatment characteristics.