The validity of conduct disorder symptom profiles in high-risk male youth.

Conduct disorder (CD) is a heterogeneous pattern of rule-breaking and aggressive symptoms. Until now it has been unclear whether valid, clinically useful symptom profiles can be defined for populations in youth at high-risk of CD. Interview-based psychiatric disorders, CD symptoms and officially recorded offences were assessed in boys from a detention facility and a forensic psychiatric hospital (N = 281; age 11.2-21.3 years). We used latent class analyses (LCA) to examine CD subtypes and their relationships with comorbid psychiatric disorders, suicidality, and criminal recidivism. LCA revealed five CD subtypes: no CD, mild aggressive CD, mild covert CD, moderate CD, and severe CD. The severe and, to a lesser degree, the moderate CD subtype were related to comorbid attention deficit hyperactivity disorder, substance use disorder, affective disorder, and suicidality. Time to violent criminal re-offending was predicted by severe CD (OR 5.98, CI 2.5-13.80) and moderate CD (OR 4.18, CI 1.89-9.21), but not by any other CD subtype in multivariate Cox regressions (controlling for age, low socioeconomic status and foreign nationality). These results confirm the existence of different CD symptom profiles in a high-risk group. Additional variable-oriented analyses with CD symptom count and aggressive/rule-breaking CD-dimensions further supported a dimensional view and a dose-response relationship of CD and criminal recidivism. Classifying high-risk young people according to the number of aggressive and rule-breaking CD symptoms is of major clinical importance and may provide information about risk of violent recidivism

Sexualized Behavior Among Adolescents Who Sexually Offended

Early or excessive sexualized behaviors and preoccupations with sexuality (SB) exhibited by juveniles who have sexually offended (JSO) are considered risk factors for sexual recidivism. However, research into SB among JSO is scarce. The present study retrospectively examined prevalence rates and patterns of SB among JSO prior to sexual offending and their relation to psychopathology and sexual recidivism. We systematically assessed information from psychiatric and psychological expert reports in case files of 230 JSO aged 12–18 years (M = 14.46, SD = 1.49) from a population sample of JSO with contact sexual offenses. A total of 93 (40.4%) JSO exhibited SB prior to the index sexual offense. Latent class analysis revealed three SB profiles: (1) “low/no SB” (n = 188), (2) “preoccupied SB” (preoccupation with sexuality, e.g., early pornography consumption, excessive masturbation; n = 29), and (3) “dysregulated SB” (exhibiting inappropriate sexualized behaviors toward others, e.g., sexualized speech, touching others inappropriately; n = 13). The preoccupied SB and the dysregulated SB groups showed higher prevalence of psychiatric disorders than the low/no SB. However, none of the JSO of the preoccupied SB or dysregulated SB groups reoffended sexually within 365 days after conviction for the sexual index offense (low/no SB: 12.8%). Overall, our findings do not support a general notion of the presence of SB as an indicator of high risk for persistent sexual offending among JSO. Instead, JSO with SB appear particularly burdened regarding a range of psychiatric disorders that should be treated accordingly

Adverse Childhood Experiences, Personality, and Crime: Distinct Associations among a High-Risk Sample of Institutionalized Youth

Despite high rates of adverse childhood experiences (ACEs) and personality-related distur bances among delinquent juveniles, associations among ACEs, youth personality, and juvenile crime involvement are still unclear. High-risk samples of institutionalized youth are in specific need of a comprehensive assessment of ACEs and personality features in order to broaden the current knowl edge on the occurrence and persistence of juvenile crime and to derive implications for prevention and intervention. We examined a heterogeneous high-risk sample of 342 adolescents (35.1% females, 64.9% males) aged between 12 and 18 years (M = 15.74, SD = 1.61 years) living in child-welfare or ju venile justice institutions regarding cumulative ACEs, psychopathic traits, temperament, and clinical personality disorder ratings, and criminal involvement before and up to 10 years after assessment. We found considerable rates of ACEs, although cumulative ACEs did not predict future crime. Latent Profile Analysis based on dimensional measures of psychopathy, temperament, and personality disorders derived six distinct personality profiles, which were differently related to ACEs, personality disturbances, clinical psychopathology, and future delinquency. A socially difficult personality profile was associated with increased risk of future crime, whereas avoidant personality traits appeared protective. Findings indicate that the role of ACEs in the prediction of juvenile delinquency is still not sufficiently clear and that relying on single personality traits alone is insufficient in the explanation of juvenile crime

Adverse Childhood Experiences, Personality, and Crime: Distinct Associations among a High-Risk Sample of Institutionalized Youth

Despite high rates of adverse childhood experiences (ACEs) and personality-related disturbances among delinquent juveniles, associations among ACEs, youth personality, and juvenile crime involvement are still unclear. High-risk samples of institutionalized youth are in specific need of a comprehensive assessment of ACEs and personality features in order to broaden the current knowledge on the occurrence and persistence of juvenile crime and to derive implications for prevention and intervention. We examined a heterogeneous high-risk sample of 342 adolescents (35.1% females, 64.9% males) aged between 12 and 18 years (M = 15.74, SD = 1.61 years) living in child-welfare or juvenile justice institutions regarding cumulative ACEs, psychopathic traits, temperament, and clinical personality disorder ratings, and criminal involvement before and up to 10 years after assessment. We found considerable rates of ACEs, although cumulative ACEs did not predict future crime. Latent Profile Analysis based on dimensional measures of psychopathy, temperament, and personality disorders derived six distinct personality profiles, which were differently related to ACEs, personality disturbances, clinical psychopathology, and future delinquency. A socially difficult personality profile was associated with increased risk of future crime, whereas avoidant personality traits appeared protective. Findings indicate that the role of ACEs in the prediction of juvenile delinquency is still not sufficiently clear and that relying on single personality traits alone is insufficient in the explanation of juvenile crime

The use of the development and well-being assessment (DAWBA) in clinical practice: a randomized trial

The development and well-being assessment (DAWBA) has been used in various epidemiological studies, whereas the clinical value of the instrument needs support from further studies. In particular, it is important to document how the use of the DAWBA influences clinical decision-making. The present study employed the DAWBA in a consecutive series of 270 new referrals to a large public child and adolescent psychiatric service in Zurich, Switzerland. ICD-10 based diagnoses were obtained from clinicians for all patients and reliability of DAWBA expert raters was calculated. The DAWBA diagnoses were randomly disclosed (n=144) or not disclosed (n=126) before clinical decision-making. The reliability of DAWBA expert diagnoses was very satisfactory and the agreement under the disclosed versus the non-disclosed condition amounted to 77 versus 68% for internalizing disorders and to 63 versus 71% for externalizing disorders. The increment in agreement due to disclosure of the DAWBA diagnosis was significant for internalizing disorders. Access to DAWBA information was more likely to prompt clinicians to add an extra diagnosis. Professional background and degree of clinical experience did not affect diagnostic agreement. Overall, diagnostic agreements between DAWBA expert diagnoses and clinical diagnoses were in the fair to moderate range and comparable to previous studies with other structured diagnostic interviews. The inclusion of the DAWBA into the clinical assessment process had an impact on diagnostic decision-making regarding internalizing disorders but not regarding externalizing disorder

The contribution of parent and youth information to identify mental health disorders or problems in adolescents

BACKGROUND Discrepancies between multiple informants often create considerable uncertainties in delivering services to youth. The present study assessed the ability of the parent and youth scales of the Strength and Difficulties Questionnaire (SDQ) to predict mental health problems/disorders across several mental health domains as validated against two contrasting indices of validity for psychopathology derived from the Development and Well Being Assessment (DAWBA): (1) an empirically derived computer algorithm and (2) expert based ICD-10 diagnoses. METHODS Ordinal and logistic regressions were used to predict any problems/disorders, emotional problems/disorders and behavioural problems/disorders in a community sample (n = 252) and in a clinic sample (n = 95). RESULTS The findings were strikingly similar in both samples. Parent and youth SDQ scales were related to any problem/disorder. Youth SDQ symptom and impact had the strongest association with emotional problems/disorder and parent SDQ symptom score were most strongly related to behavioural problems/disorders. Both the SDQ total and the impact scores significantly predicted emotional problems/disorders in males whereas this was the case only for the total SDQ score in females. CONCLUSION The present study confirms and expands previous findings on parent and youth informant validity. Clinicians should include both parent and youth for identifying any mental health problems/disorders, youth information for detecting emotional problems/disorders, and parent information to detect behavioural problems/disorders. Not only symptom scores but also impact measures may be useful to detect emotional problems/disorders, particularly in male youth

Problem coping skills, psychosocial adversities and mental health problems in children and adolescents as predictors of criminal outcomes in young adulthood

Abstract : The purpose of this study was to test child and adolescent psychosocial and psychopathological risk factors as predictors of adult criminal outcomes in a Swiss community sample. In particular, the role of active and avoidant problem coping in youths was analysed. Prevalence rates of young adult crime convictions based on register data were calculated. Univariate and multivariate logistic regressions were used to analyse the prediction of adult criminal convictions 15years after assessment in a large Swiss community sample of children and adolescents (n=1,086). Risk factors assessed in childhood and adolescence included socio-economic status (SES), migration background, perceived parental behaviour, familial and other social stressors, coping styles, externalizing and internalizing problems and drug abuse including problematic alcohol consumption. The rate of any young adult conviction was 10.1%. Besides externalizing problems and problematic alcohol consumption, the presence of any criminal conviction in young adulthood was predicted by low SES and avoidant coping even after controlling for the effects of externalizing problems and problematic alcohol use. The other predictors were significant only when externalizing behaviours and problematic alcohol use were not controlled. In addition to child and adolescent externalizing behaviour problems and substance use, low SES and inadequate problem-solving skills, in terms of avoidant coping, are major risk factors of young adult criminal outcomes and need to be considered in forensic research and criminal prevention programs

Randomized, Controlled Trial of the Long Term Safety, Immunogenicity and Efficacy of RTS,S/AS02(D) Malaria Vaccine in Infants Living in a Malaria-Endemic Region.

The RTS,S/AS malaria candidate vaccine is being developed with the intent to be delivered, if approved, through the Expanded Programme on Immunization (EPI) of the World Health Organization. Safety, immunogenicity and efficacy of the RTS,S/AS02(D) vaccine candidate when integrated into a standard EPI schedule for infants have been reported over a nine-month surveillance period. This paper describes results following 20 months of follow up. This Phase IIb, single-centre, randomized controlled trial enrolled 340 infants in Tanzania to receive three doses of RTS,S/AS02(D) or hepatitis B vaccine at 8, 12, and 16 weeks of age. All infants also received DTPw/Hib (diphtheria and tetanus toxoids, whole-cell pertussis vaccine, conjugated Haemophilus influenzae type b vaccine) at the same timepoints. The study was double-blinded to month 9 and single-blinded from months 9 to 20. From month 0 to 20, at least one SAE was reported in 57/170 infants who received RTS,S/AS02(D) (33.5%; 95% confidence interval [CI]: 26.5, 41.2) and 62/170 infants who received hepatitis B vaccine (36.5%; 95% CI: 29.2, 44.2). The SAE profile was similar in both vaccine groups; none were considered to be related to vaccination. At month 20, 18 months after completion of vaccination, 71.8% of recipients of RTS,S/AS02(D) and 3.8% of recipients of hepatitis B vaccine had seropositive titres for anti-CS antibodies; seroprotective levels of anti-HBs antibodies remained in 100% of recipients of RTS,S/AS02(D) and 97.7% recipients of hepatitis B vaccine. Anti-HBs antibody GMTs were higher in the RTS,S/AS02(D) group at all post-vaccination time points compared to control. According to protocol population, vaccine efficacy against multiple episodes of malaria disease was 50.7% (95% CI: -6.5 to 77.1, p = 0.072) and 26.7% (95% CI: -33.1 to 59.6, p = 0.307) over 12 and 18 months post vaccination, respectively. In the Intention to Treat population, over the 20-month follow up, vaccine efficacy against multiple episodes of malaria disease was 14.4% (95% CI: -41.9 to 48.4, p = 0.545). The acceptable safety profile and good tolerability of RTS,S/AS02(D) in combination with EPI vaccines previously reported from month 0 to 9 was confirmed over a 20 month surveillance period in this infant population. Antibodies against both CS and HBsAg in the RTS,S/AS02(D) group remained significantly higher compared to control for the study duration. Over 18 months follow up, RTS,S/AS02(D) prevented approximately a quarter of malaria cases in the study population. CLINICAL TRIALS: Gov identifier: NCT00289185

Virosome-Formulated Plasmodium falciparum AMA-1 & CSP Derived Peptides as Malaria Vaccine: Randomized Phase 1b Trial in Semi-Immune Adults & Children

BACKGROUND\ud \ud This trial was conducted to evaluate the safety and immunogenicity of two virosome formulated malaria peptidomimetics derived from Plasmodium falciparum AMA-1 and CSP in malaria semi-immune adults and children.\ud \ud METHODS\ud \ud The design was a prospective randomized, double-blind, controlled, age-deescalating study with two immunizations. 10 adults and 40 children (aged 5-9 years) living in a malaria endemic area were immunized with PEV3B or virosomal influenza vaccine Inflexal®V on day 0 and 90.\ud \ud RESULTS\ud \ud No serious or severe adverse events (AEs) related to the vaccines were observed. The only local solicited AE reported was pain at injection site, which affected more children in the Inflexal®V group compared to the PEV3B group (p = 0.014). In the PEV3B group, IgG ELISA endpoint titers specific for the AMA-1 and CSP peptide antigens were significantly higher for most time points compared to the Inflexal®V control group. Across all time points after first immunization the average ratio of endpoint titers to baseline values in PEV3B subjects ranged from 4 to 15 in adults and from 4 to 66 in children. As an exploratory outcome, we found that the incidence rate of clinical malaria episodes in children vaccinees was half the rate of the control children between study days 30 and 365 (0.0035 episodes per day at risk for PEV3B vs. 0.0069 for Inflexal®V; RR  = 0.50 [95%-CI: 0.29-0.88], p = 0.02).\ud \ud CONCLUSION\ud \ud These findings provide a strong basis for the further development of multivalent virosomal malaria peptide vaccines.\ud \ud TRIAL REGISTRATION\ud \ud ClinicalTrials.gov NCT00513669