Understanding Uniqueness and Diversity in Child and Adolescent Mental Health

Matthew Hodes, Susan Shur-Fen Gau, Petrus J. De Vries

• Publisher: Academic Press
• Year: 2018
• ISBN:
  9780128153116
• Topic: Psychologie
• Subtopic: Psychologie du développement

Understanding Uniqueness and Diversity in Child and Adolescent Mental Health examines the determinates of individual differences in children and young people, along with the origins of maladjustment and psychiatric disorders. It addresses the ways in which interventions and mental health services can be developed and shaped to address individual differences amongst children. Topics cover the influence of economic adversities and gender differences on child development and life course, as well as the range of risk and protective factors associated with the onset and persistence of problems, including sections on anxiety disorders in infants, bipolar disorder, and tics and Tourette's.

Additional sections focus on the potential for individualizing treatments as illustrated by pharmacogenomics, with another highlighting ways in which services can be adapted for specific environments, such as the needs of refugee children and systems of service delivery that can be enhanced by the use of telemedicine.

• Emphasizes the social and environmental influences on child and adolescent mental health
• Focuses on early developmental and infancy processes
• Addresses the training of child and adolescent psychiatrists across Europe
• Covers a range of illustrative psychiatric disorders and problems
• Forwards a goal of producing a mental health workforce with internationally recognized competencies

Part I

Understanding Diversity in Development and Psychopathology

Outline

1. Chapter 1. Variations in Pathways Into and Out of Antisocial Behavior From the Perspective of Developmental Psychopathology
2. Chapter 2. Developmental Considerations in Bipolar Disorder
3. Chapter 3. Heterogeneity in Tics and Gilles de la Tourette Syndrome
4. Chapter 4. Risk and Protective Factors and Course of Functional Somatic Symptoms in Young People
5. Chapter 5. Anxiety and Anxiety Disorders in Young People: A Cross-Cultural Perspective

Chapter 1

Variations in Pathways Into and Out of Antisocial Behavior From the Perspective of Developmental Psychopathology

Eric Acquaviva¹, Pierre Ellul¹, and Xavier Benarous^{2,3 1}Hôpital Robert Debré, Paris, France ²Pitié-Salepêtrière Hospital, Sorbonne University, Paris, France ³INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France

Abstract

Antisocial behaviors in children and adolescents are heterogeneous. Given the developmental changes occurring around adolescence, antisocial behaviors become less frequent as young people pass into late adolescence and adulthood. However, some people exhibit severe and persistent behavioral difficulties associated with a high level of functional impairment. In recent decades, a substantial amount of research literature has been devoted to identifying homogeneous subgroups of children and adolescents with antisocial behaviors, to better identify the natural course of symptoms and ultimately to improve quality of care. Cumulative scientific data showed that the early onset of antisocial behaviors and a lack of prosocial emotion predict a poor prognosis. This position was finally endorsed in the influential American psychiatric classificatory system, in which these features are considered to specify the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnosis of conduct disorder (CD). Other factors including psychiatric comorbidities and cognitive characteristics affect the pathways of antisocial behaviors. The interplay between genetic and environmental factors is also implicated in the course of these difficulties. The need for a better understanding of antisocial behavior pathways and better management of patients with CDs is crucial.

Keywords

Antisocial behaviors; Callous-unemotional trait; Conduct disorders; Pathways; Prevention

Introduction

Antisocial behaviors refers to a heterogeneous set of actions outside the norms, rules, or laws of the social group in which the subject develops, such as physical aggression, theft, and violation of societal rules. Such behaviors may have a number of medical and social implications (Nau, 2005). For example, in France, a review ordered by the National Medical Research Institute in 2006 (Institut National de la Santé et de la Recherche Médicale, France, 2006) sparked an intense debate in the medical and scientific fields. The discussions focused on the use of early predictors for antisocial behaviors, which was interpreted by some to be a source of social stigma of at-risk populations as well as a determinist interpretation of disadvantaged populations (Ehrenberg, 2006; Lenoble, E., Malika, B.-B., Sandrine, C., & Forget, J.-M., 2006).

In daily practice, clinicians are often requested by families or institutions to be involved in caring for children and adolescents with antisocial or defiant behaviors when first-line educational interventions fail.

It is important to take into account that exhibiting some antisocial behavior such as lying or theft is often considered the norm for children; however, such expressions are generally limited in time and number. For example, a peak in physical aggression is observed at age 3 in both boys and girls, with an expected decline following the emergence of the child's socioemotional skills (Tremblay, 2002). Antisocial behaviors can be seen in almost all contexts of psychopathology in children and adolescents, from a maladaptive reaction to stressful family situations to its episodic expression during an acute psychiatric episode (e.g., depressive episode, mania, or psychotic episode). Children who exhibit persistent and repetitive antisocial behaviors are defined in international classifications as having conduct disorders (CD).

The prevalence of CD in children and adolescents is high (2.7%–5.2%) and both crises and life trajectories of these children and adolescents are difficult to manage for families, institutions, and themselves (Costello, Mustillo, Erkanli, Keeler, & Angold, 2003; Kessler et al., 2012).

The first study on the natural course of antisocial behaviors from childhood to adulthood was conducted by Robins (Robins, 1966). She examined at age 30 years 406 people who had been referred to a child guidance center at age 13 years. All subjects who had committed serious offenses in adulthood had shown antisocial behaviors in childhood. Among the outcomes in adulthood, 12% of youths with antisocial behavior had complete remission, 27% had partial improvement (more than three antisocial symptoms), and 61% remained unimproved in adulthood. Since this seminal work, a large amount of empirical data highlighted the assumption that the persistence of antisocial behaviors throughout the life span is a main risk for youths with CD. A systematic review reported that 40%–70% of youths with CD evolve into having an antisocial personality disorder in adulthood (R.J.R. Blair, 2015; National Collaborating Centre for Mental Health (UK) & Social Care Institute for Excellence (UK), 2013). When antisocial behaviors persist in adulthood, they are associated with dramatically elevated morbidity and mortality. For this group, the risk of premature death at age 40 is 33 times higher than that for the general population (Black, Baumgard, Bell, & Kao, 1996). Young adults with antisocial problems are at particular risk for trauma, sexually transmitted infections, and toxic-related infections (hepatitis C virus and HIV). Compliance with managing a medical problem (such as epilepsy) is often problematic and access to care services is chaotic (Black & Donald, 2015).

The need to develop effective interventions to reduce antisocial behaviors in childhood has become increasingly recognized by public health policy makers. In addition to preventive programs in the general population, the development of targeted prevention interventions for specific subgroups of youths is seen as an important approach. This requires a better understanding of the variety of pathways into and out of antisocial behaviors throughout the life span, and a definition of relevant subgroups of patients. In the early 1990s, Moffit (T.E. Moffitt, 1993) suggested that the onset of difficulties may differentiate groups of patients with distinct trajectories of antisocial behaviors, i.e., life course–persistent disorder (LCP) and adolescent-limited (AL) conduct problems. Another distinction was made with regard to the presence of prosocial emotions. Considering the vast number of studies addressing these questions, an updated review of this topic is needed.

This chapter synthesizes the studies on the variability of clinical expression and trajectories into and out of antisocial behaviors from a developmental point of view. First, we will describe how antisocial behaviors are categorized in the international classifications and how these classifications differentiate clinical subtypes and trajectories of antisocial behaviors. Second, we show how comorbidities are associated with different trajectories of antisocial behaviors. Then, we will consider the neuropsychological characteristics associated with specific pathways of antisocial behaviors. Finally, genetic and neurobiological factors involved in these trajectories are discussed.

Subtypes of Antisocial Behaviors in International Classifications

General Background

In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (American Psychiatric Association, 2013), children and adolescents receive a diagnosis of CD according to the consideration of four domains: (1) aggression to people or animals, (2) destruction of property, (3) deceitfulness or theft, and (4) serious violation of rules. CD is diagnosed when there is a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated. The presence of at least 3 of 15 criteria in the past 12 months from any of these categories, with at least one criterion present in the past 6 months, is required. Moreover, “the disturbance in behaviour causes clinically significant impairment in social, academic, or occupational functioning.” The International Classification of Disease, 10th Revision (ICD-10) (Organisation Mondiale de la Santé, 19...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• List of Contributors
• Preface
• Introduction
• Part I. Understanding Diversity in Development and Psychopathology
• Part II. Uniqueness and Risk in Marginalized Groups
• Part III. Supporting Uniqueness and Diversity Through Interventions and Services
• Part IV. European Perspectives on Child and Adolescent Mental Health Services and Training
• Index