Multilevel strategies to end HIV for young couples in Cape Town: Study protocol for a cluster randomized trial.

This protocol presents a multilevel cluster randomized study in 24 communities in Cape Town, South Africa. The study comprises four specific aims. Aim 1, conducted during the formative phase, was to modify the original Couples Health CoOp (CHC) intervention to include antiretroviral therapy/pre-exposure prophylaxis (ART/PrEP), called the Couples Health CoOp Plus (CHC+), with review from our Community Collaborative Board and a Peer Advisory Board. Aim 1 has been completed for staging the trial. Aim 2 is to evaluate the impact of a stigma awareness and education workshop on community members' attitudes and behaviors toward young women and men who use AODs and people in their community seeking HIV services (testing/ART/PrEP) and other health services in their local clinics. Aim 3 is to test the efficacy of the CHC+ to increase both partners' PrEP/ART initiation and adherence (at 3 and 6 months) and to reduce alcohol and other drug use, sexual risk and gender-based violence, and to enhance positive gender norms and communication relative to HIV testing services (n = 480 couples). Aim 4 seeks to examine through mixed methods the interaction of the stigma awareness workshop and the CHC+ on increased PrEP and ART initiation, retention, and adherence among young women and their primary partners. Ongoing collaborations with community peer leaders and local outreach staff from these communities are essential for reaching the project's aims. Additionally, a manualized field protocol with regular training, fidelity checks, and quality assurance are critical components of this multilevel community trial for successful ongoing data collection. Trial registration. Clinicaltrials.gov Registration Number: NCT05310773. Pan African Trials: pactr.samrc.ac.za/ Registration Number: PACTR202205640398485.

Brief Report: HIV Testing and Risk Among Justice-Involved Youth.

Justice-involved youth have a number of risk factors for HIV infection, including high rates of substance use, psychiatric comorbidities, and risky sexual behaviors. Although detained youth are likely to receive health care-which may include HIV testing-court-involved, non-incarcerated (CINI) youth may be unlikely to receive HIV testing services either before or during their justice involvement. However, the relationship between risk factors and HIV testing among CINI youth is largely unknown. We explored the association between HIV testing and factors commonly associated with both HIV testing and HIV risk among 173 CINI youth with identified behaviors that put them at risk for HIV acquisition. Only 15.6% of participants reported a lifetime history of HIV testing, despite high rates of sexual and substance use risk behaviors. Age (older), gender (female), sexual orientation (non-heterosexual), recent marijuana use, lifetime use of other drugs, history of a sexually transmitted infection, pap smear in the past year and history of mental health/substance use treatment were all significantly associated with lifetime HIV testing. The extremely low testing rates in this sample emphasize that the juvenile justice system outside of detention is not adequately addressing youths' needs related to HIV testing or ensuring access to testing services for youth at risk of contracting HIV. Results suggest that additional efforts are needed to connect justice-involved youth to healthcare more broadly and HIV testing in particular.

Mental Health Symptoms and Delinquency among Court-Involved Youth Referred for Treatment.

Youth involved in the justice system meet criteria for psychiatric disorders at much higher rates than youth in the general population and a large body of research has established a relationship between mental health problems and delinquency or recidivism. However, only limited research has examined the relationship between specific types of psychopathology and specific patterns or types of delinquency for justice-involved youth and only a single study has explored the relationship between psychopathology and delinquency among youth with psychiatric diagnoses receiving mental health treatment. We examined the relationship between severity of offending and internalizing and externalizing symptoms among court-involved, non-incarcerated youth referred for mental health treatment. Over half of youth and over two-thirds of parents reported youth symptomatology at the 93rd percentile or above for internalizing symptoms, externalizing symptoms, or both. We found that youth engaged in serious or violent delinquency are more likely to have externalizing problems but that internalizing symptoms were equally high across youth committing minor, moderate, and serious delinquent acts. Findings from this study support the need for future research exploring the nuances of relationships between psychiatric disorder and patterns of delinquency, which can provide helpful information to justice system stakeholders in identifying youth needs.

Juvenile Justice Anger Management (JJAM) Treatment for Girls: Results of a randomized controlled trial.

This study examined the efficacy of the Juvenile Justice Anger Management (JJAM) Treatment for Girls, an anger management and aggression reduction treatment designed to meet the unique needs of adolescent girls in residential juvenile justice facilities. This randomized controlled trial of JJAM compared changes in levels of anger and aggression among girls who participated in the JJAM treatment with those of girls who participated in treatment as usual (TAU) at the facilities. This study also investigated the theoretical model underlying the JJAM treatment, which proposed that reductions in hostile attribution biases, development of emotion regulation skills, and improvement in social problem solving would serve as mechanisms of action in JJAM. Participants were 70 female youth who ranged in age from 14 to 20 years (M = 17.45, SD = 1.24) and were placed at 1 of 3 participating juvenile justice facilities; 57 youth completed the study and were included in analyses. Results revealed greater reductions in anger, reactive physical aggression, and reactive relational aggression among girls in the JJAM treatment condition when compared to girls in the TAU control condition. The proposed theoretical model was partially supported via significant mediation findings; changes in hostile attribution bias were identified as a significant mechanism of action in the JJAM treatment. Results suggest that JJAM is a promising treatment to effectively reduce anger and reactive aggression among adolescent girls in juvenile justice placements. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Diagnostic Changes to DSM-5: The Potential Impact on Juvenile Justice.

Legal decision-makers have discretion at every stage of processing in the juvenile justice system, and individual youth characteristics (e.g., a particular psychiatric diagnosis) influence how a youth progresses through the system. As a result, changes in diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) may affect the rates of diagnoses among justice-involved youths and subsequently influence youths' experiences within the justice system. In this article, we identify the diagnoses most likely to exert such influences and review the prevalence of diagnosis and psychiatric disorder symptomatology in justice-involved youths. We highlight the DSM-5 changes in diagnostic criteria for internalizing and externalizing disorders that commonly occur among justice-involved youths and the potential impact of these changes on the rates of diagnoses within this population. Finally, we address the limitations of using psychiatric diagnoses in juvenile justice decision making, including the potential for biasing legal decision-makers and the importance of considering context as part of diagnosis.

Success in School for Justice-Involved Girls: Do Specific Aspects of Developmental Immaturity Matter?

Developmental immaturity (DI) may help explain some of the variability in aspects of academic achievement among girls in the juvenile justice system, a population with high rates of truancy, dropout, and school failure. This study examined the relationships among the decision making and independent functioning components of DI, verbal intelligence, and academic achievement within this population. Using data from 60 girls in residential juvenile justice facilities, multiple regression analyses indicated that verbal IQ moderated the relationship between the DI construct of decision making and academic achievement. Self-reported school attendance and number of previous arrests did not significantly mediate the relationship between DI and academic achievement. These results may indicate that the decision-making factor of DI may be particularly important, and, if results are replicated, future intervention efforts could focus more on improving this skill within this juvenile justice population. Additionally, the overall importance of the full DI construct is an important area of future study.

DTI-measured white matter abnormalities in adolescents with Conduct Disorder.

Emerging research suggests that antisocial behavior in youth is linked to abnormal brain white matter microstructure, but the extent of such anatomical connectivity abnormalities remain largely untested because previous Conduct Disorder (CD) studies typically have selectively focused on specific frontotemporal tracts. This study aimed to replicate and extend previous frontotemporal diffusion tensor imaging (DTI) findings to determine whether noncomorbid CD adolescents have white matter microstructural abnormalities in major white matter tracts across the whole brain. Seventeen CD-diagnosed adolescents recruited from the community were compared to a group of 24 non-CD youth which did not differ in average age (12-18) or gender proportion. Tract-based spatial statistics (TBSS) fractional anisotropy (FA), axial diffusivity (AD), and radial diffusivity (RD) measurements were compared between groups using FSL nonparametric two-sample t test, clusterwise whole-brain corrected, p < .05. CD FA and AD deficits were widespread, but unrelated to gender, verbal ability, or CD age of onset. CD adolescents had significantly lower FA and AD values in frontal lobe and temporal lobe regions, including frontal lobe anterior/superior corona radiata, and inferior longitudinal and fronto-occipital fasciculi passing through the temporal lobe. The magnitude of several CD FA deficits was associated with number of CD symptoms. Because AD, but not RD, differed between study groups, abnormalities of axonal microstructure in CD rather than myelination are suggested. This study provides evidence that adolescent antisocial disorder is linked to abnormal white matter microstructure in more than just the uncinate fasciculus as identified in previous DTI studies, or frontotemporal brain structures as suggested by functional neuroimaging studies. Instead, neurobiological risk specific to antisociality in adolescence is linked to microstructural abnormality in numerous long-range white matter connections among many diverse different brain regions.

Comparison of brain volume abnormalities between ADHD and conduct disorder in adolescence.

BACKGROUND: Previous studies of brain structure abnormalities in conduct disorder and attention-deficit/hyperactivity disorder (ADHD) samples have been limited owing to cross-comorbidity, preventing clear understanding of which structural brain abnormalities might be specific to or shared by each disorder. To our knowledge, this study was the first direct comparison of grey and white matter volumes in diagnostically "pure" (i.e., no comorbidities) conduct disorder and ADHD samples. METHODS: Groups of adolescents with noncormobid conduct disorder and with noncomorbid, combined-subtype ADHD were compared with age- and sex-matched controls using DARTEL voxel-based analysis of T1-weighted brain structure images. Analysis of variance with post hoc analyses compared whole brain grey and white matter volumes among the groups. RESULTS: We included 24 adolescents in each study group. There was an overall 13% reduction in grey matter volume in adolescents with conduct disorder, reflecting numerous frontal, temporal, parietal and subcortical deficits. The same grey matter regions typically were not abnormal in those with ADHD. Deficits in frontal lobe regions previously identified in studies of patients with ADHD either were not detected, or group differences from controls were not as strong as those between the conduct disorder and control groups. White matter volume measurements did not differentiate conduct disorder and ADHD. LIMITATIONS: Our modest sample sizes prevented meaningful examination of individual features of ADHD or conduct disorder, such as aggression, callousness, or hyperactive versus inattentive symptom subtypes. CONCLUSION: The evidence supports theories of frontotemporal abnormalities in adolescents with conduct disorder, but raises questions about the prominence of frontal lobe and striatal structural abnormalities in those with noncomorbid, combined-subtype ADHD. The latter point is clinically important, given the widely held belief that ADHD is associated with numerous frontal lobe structural deficits, a conclusion that is not strongly supported following direct comparison of diagnostically pure groups. The results are important for future etiological studies, particularly those seeking to identify how early expression of specific brain structure abnormalities could potentiate the risk for antisocial behaviour.

Cortical thickness and folding deficits in conduct-disordered adolescents.

BACKGROUND: Studies of pediatric conduct disorder (CD) have described frontal and temporal lobe structural abnormalities that parallel findings in antisocial adults. The purpose of this study was to examine previously unexplored cortical thickness and folding as markers for brain abnormalities in "pure CD"-diagnosed adolescents. On the basis of current frontotemporal theories, we hypothesized that CD youth would have thinner cortex or less cortical folding in temporal and frontal lobes than control subjects. METHODS: We obtained T1-weighted brain structure images from 24 control and 19 CD participants aged 12 to 18 years, matched by gender and age. We measured group differences in cortical thickness and local gyrification index (regional cortical folding measure) using surface-based morphometry with clusterwise correction for multiple comparisons. RESULTS: The CD participants, compared with control subjects, showed both reduced cortical thickness and folding. Thinner cortex was located primarily in posterior brain regions, including left superior temporal and parietal lobes, temporoparietal junction and paracentral lobule, right superior temporal and parietal lobes, temporoparietal junction, and precuneus. Folding deficits were located mainly in anterior brain regions and included left insula, ventro- and dorsomedial prefrontal, anterior cingulate and orbitofrontal cortices, temporal lobe, right superior frontal and parietal lobes, and paracentral lobule. CONCLUSIONS: Our findings generally agree with previous CD volumetric studies but here show the unique contributions of cortical thickness and folding to gray matter reductions in pure CD in different brain regions.