Gender dysphoria in adolescent population: A 5-year replication study.

The aim of this study was to explore whether there has been an increase in prevalence and changes in sex ratio in feelings of gender dysphoria (GD) in an adolescent population in Northern Europe, and to study the impact of invalid responding on this topic. We replicated an earlier survey among junior high school students in Tampere, Finland. All first and second year students, aged 16-18, in the participating schools were invited to respond to an anonymous classroom survey on gender experience during the 2012-2013 school year and in the spring and autumn terms of 2017. Gender identity/GD was measured using the GIDYQ-A. A total of 318 male and 401 female youth participated in 2012-2013, and 326 male and 701 female youth in 2017. In the earlier survey, the GIDYQ-A scores, both among males and females, were strongly skewed toward a cis-gender experience with very narrow interquartile ranges. Of males, 2.2%, and of females, 0.5% nevertheless reported possibly clinically significant GD. The 2017 GIDYQ-A distribution was similarly skewed. The proportion of those reporting potentially clinically significant GD was 3.6% among males and 2.3% among females. Validity screening proved to have a considerable impact on conclusions. GD seems to have increased in prevalence in the adolescent population.

Sexual experiences of clinically referred adolescents with features of gender dysphoria.

Gender dysphoria in adolescence could be expected to be associated with delayed sexual development because of the distress related to the sexual characteristics of the body. However, identity challenges may also increase early and risk-taking sexual behaviours among adolescents with gender dysphoria. We studied sexual experiences among 101 adolescents, attending an adolescent gender identity service, desiring gender reassignment. Their experiences were compared to the sexual experiences of the same-aged population, evaluated in a large adolescent survey. A majority of adolescents with gender dysphoria had been in love or had a crush on somebody. Birth assigned females had experiences of romantic relationships twice as commonly as birth assigned males. Otherwise, there was no statistically significant difference in the adolescents' sexual experiences. About half of the subjects had experiences of kissing, and about 40% had intimate (genital) sexual experiences with a partner. Compared to the general adolescent population, adolescents with gender dysphoria were less experienced. Autism spectrum disorder was associated with more delayed sexual development.

Socioeconomic Trends in Adolescent Smoking in Finland From 2000 to 2015.

PURPOSE: Smoking is a significant cause of morbidity and mortality worldwide. In the past decades, the prevalence of adolescent smoking has decreased in industrial countries. However, whether the decreasing trend can be seen across all socioeconomic groups is unknown. The aim of this study was to examine time trends in adolescent smoking according to the socioeconomic status among Finnish adolescents between 2000 and 2015. METHODS: A population-based school survey was conducted biennially among 14- to 16-year-old Finns between 2000 and 2015 (n = 761,278). Distributions for frequent smoking, lifelong nonsmoking, and socioeconomic adversities (low parental education, not living with both parents and parental unemployment during the past year) were calculated. Associations were studied using binomial logistic regression results shown by odds ratios with 95% confidence intervals. RESULTS: Frequent smoking was positively associated and lifelong nonsmoking was negatively associated with socioeconomic adversities. Over the study period, the overall prevalence of frequent smoking decreased and lifelong nonsmoking increased. However, no similar changes were observed among adolescents with most socioeconomic adversities. CONCLUSION: Socioeconomic differences in adolescent smoking increased in Finland between 2000 and 2015. Although the overall prevalence of frequent smoking decreased, no similar decrease was observed among adolescents with most socioeconomic adversities. Similarly, although the overall prevalence of lifelong nonsmoking increased, this was not observed among adolescents with most socioeconomic adversities. Socioeconomic adversities should be considered in the prevention of adolescent smoking.

Overview of European forensic youth care: towards an integrative mission for prevention and intervention strategies for juvenile offenders.

All over Europe youth delinquency is decreasing; our understanding of the factors related to juvenile delinquency and the characteristics of effective forensic youth care has increased substantially. However, effective prevention and intervention strategies are not always employed due to financial, demographical and socio-political challenges countries face, while the burden of mental health in juvenile justice populations is high. With this commentary, we highlight the importance of international collaboration to set out a direction to improve forensic youth care, to bundle our strengths and overcome our challenges. It is a continuation of the course that was set out by Doreleijers and Fegert (Child Adolesc Psychiatry Ment Health 5:20, 2011), in their editorial they highlighted the importance of collaboration and presented an overview of the state of the art on forensic youth care in eight European countries (and Russia). With this manuscript, we present an overview of statistics in juvenile justice of all European countries and present an integrated mission statement for forensic youth care, which was formulated in a keynote debate at the 6th biennial congress of the European Association for Forensic Child and Adolescent Psychiatry, Psychology and other involved professions (EFCAP).

Adolescents with same-sex interest: experiences of sexual harassment are more common among boys.

Purpose: To explore whether sexual harassment experiences are more common among adolescents reporting romantic and erotic interests in the same sex and both sexes, when sociodemographic and mental health confounding are controlled for, and whether the associations are similar in both sexes and in different phases of adolescence. Methods: A cross-sectional survey among a nationally representative dataset of 25,147 boys and 25,257 girls in comprehensive school, and 33,231 boys and 36,765 girls in upper secondary education. Self-reports of experiences of sexual harassment, and emotional (depression) and behavioral (delinquency) symptoms were used. Results: All associations between sexual minority status and harassment diminished clearly when mental disorder dimensions were controlled for. In the comprehensive school sample (mean age 15.4 years), sexual harassment experiences were 4-7-fold more common among boys, and 1.5-3-fold among girls, with same-sex/both-sexes interest, compared to those interested exclusively in the opposite sex. In the upper secondary education sample (mean age 17.4 years), among boys, sexual harassment was reported 3-6-fold more commonly by those not exclusively heterosexually interested. Among older girls, a slight increase in sexual harassment experiences was seen among those interested in both sexes. Conclusions: Sexual harassment experiences are associated with sexual minority status, particularly among boys. Confounding by mental disorders needs to be accounted for when studying sexual minority status and sexual harassment.

Changes in delinquency according to socioeconomic status among Finnish adolescents from 2000 to 2015.

Background: Scientific literature suggests that the prevalence of delinquency amongst adolescents has decreased internationally in past decades. However, whether this change is consistent across all socioeconomic groups has not yet been studied. Objective: The aim of this study was to examine changes in delinquency amongst Finnish adolescents according to socioeconomic status between 2000 and 2015. Method: A population-based school survey was conducted biennially amongst 14-16-year-old Finns between 2000 and 2015 (n = 761,278). Distributions for delinquency and socioeconomic adversities (low parental education, not living with both parents and parental unemployment in the past year) were calculated using crosstabs. Associations between delinquency, time, and socioeconomic adversities were studied using binomial logistic regression results shown by odds ratios with 95 % confidence intervals. Results: Delinquency was positively associated with all three socioeconomic adversities studied and cumulative socioeconomic adversity. Although the prevalence of delinquency varied only slightly between 2000 and 2015 in the overall population, it increased significantly amongst adolescents with most socioeconomic adversities. Conclusions: The findings indicate that socioeconomic differences in delinquency have increased amongst Finnish adolescents in past decades. Delinquency prevention and intervention programs should take socioeconomic adversities into account.

Gender identities in adolescent population: Methodological issues and prevalence across age groups.

BACKGROUND: Increasing numbers of adolescents are seeking treatment from gender identity services, particularly natal girls. It is known from survey studies some adolescents exaggerate their belonging to minorities, thereby distorting prevalence estimates and findings on related problems. The aim of the present study was to explore the susceptibility of gender identity to mischievous responding, and prevalences of cis-gender, opposite-sex and other/ non-binary gender identities as corrected for likely mischievous responding among Finnish adolescents. METHOD: The School Health Promotion Survey 2017 data was used, comprising data on 135,760 adolescents under 21 years (mean 15.73, ds 1.3 years), 50.6% females and 49.4% males. Sex and perceived gender were elicited and gender identities classified based thereon. Likely mischievous responding was analysed using inappropriate responses to biodata and handicaps. RESULTS: Of the participants, 3.5% had most likely given facetious responses, boys more commonly than girls, and younger adolescents more commonly than older. This particularly concerned reporting of non-binary gender identity. Corrected prevalence of opposite-sex identification was 0.6% and that of non-binary identification was 3.3%. In boys, displaying non-binary gender identity increased from early to late adolescence, while among girls, opposite-sex and non-binary identifications decreased in prevalence from younger to older age groups. CONCLUSION: Prevalence of gender identities contrary to one's natal sex was more common than expected.

Psychometric properties of the 7-item Generalized Anxiety Disorder Scale (GAD-7) in a large representative sample of Finnish adolescents.

Symptoms of generalized anxiety disorder (GAD) are common among adolescents and can lead to severe psychosocial impairment, yet there is a lack of a good quality scale to measure symptoms of generalized anxiety in young people. The 7-item Generalized Anxiety Disorder Scale (GAD-7) is a self-report scale used to measure GAD symptoms and has been validated in adult populations, but the measure's psychometric properties regarding adolescents are unknown. The aim of this study was to investigate the reliability, factorial validity, and construct validity of the GAD-7 in adolescents in a nationally representative sample from a general population. Our study was based on Finnish survey data on 111,171 adolescents aged 14-18 years. Our results show that the GAD-7 demonstrates good psychometric properties in adolescents. The internal consistency of the GAD-7 was good (Cronbach's α = 0.91) and the instrument's unidimensional factor structure was supported. The associations of GAD-7 sum scores with self-report measures of depression and social anxiety supported construct validity. The psychometric properties of the GAD-7 in this sample of adolescents were similar to those reported among adults. However, studies in which diagnostic interviews are performed are needed to demonstrate the diagnostic efficacy of the measure in this age group.

Socioeconomic trends in school bullying among Finnish adolescents from 2000 to 2015.

Bullying at school has far-reaching impacts on adolescent well-being and health. The aim of this study was to examine trends in bullying at school according to socioeconomic adversities among Finnish adolescents from 2000 to 2015. A population-based school survey was conducted biennially among 14-16-year-old Finns between 2000 and 2015 (n = 761,278). Distributions for bullying, being bullied and socioeconomic adversities were calculated. Associations between bullying involvement, time and socioeconomic adversities were studied using binomial logistic regression with results shown by odds ratios with 95% confidence intervals. At the population level, the likelihoods of bullying and being bullied varied only slightly between 2000 and 2015. Bullying and being bullied were associated with socioeconomic adversities (low parental education, not living with both parents and parental unemployment in the past year). Unlike in the general population, the likelihoods of bullying and being bullied increased markedly among adolescents with most socioeconomic adversities. The increased socioeconomic differences in bullying involvement observed in this study add to the mounting evidence of polarization of adolescent health and well-being. Socioeconomic adversities should be considered in the prevention of bullying at school. In addition, socio-political measures are needed to decrease socioeconomic inequalities among Finnish adolescents.

Gender dysphoria in adolescence: current perspectives.

Increasing numbers of adolescents are seeking treatment at gender identity services in Western countries. An increasingly accepted treatment model that includes puberty suppression with gonadotropin-releasing hormone analogs starting during the early stages of puberty, cross-sex hormonal treatment starting at ~16 years of age and possibly surgical treatments in legal adulthood, is often indicated for adolescents with childhood gender dysphoria (GD) that intensifies during puberty. However, virtually nothing is known regarding adolescent-onset GD, its progression and factors that influence the completion of the developmental tasks of adolescence among young people with GD and/or transgender identity. Consolidation of identity development is a central developmental goal of adolescence, but we still do not know enough about how gender identity and gender variance actually evolve. Treatment-seeking adolescents with GD present with considerable psychiatric comorbidity. There is little research on how GD and/or transgender identity are associated with completion of developmental tasks of adolescence.

Experiences of sexual harassment are associated with the sexual behavior of 14- to 18-year-old adolescents.

Subjection to sexual harassment is associated with a number of negative outcomes, such as internalizing and externalizing symptoms and a disinclination to attend school. Among adolescents, sexual harassment may increase with both their emerging sexual desires and increased socializing in mixed-gender peer groups during early adolescence. We set out to study the possible associations between normative and risk-taking sexual behavior and subjection to sexual harassment among adolescents between the ages of 14 and 18 years. The informants included 90,953 boys and 91,746 girls, with a mean (SD) age of 16.3 (1.2) years, who responded to a classroom survey (School Health Promotion Study 2010-2011) in Finland. We found that even early steps in romantic and erotic experiences were associated with experiences of sexual harassment. The more advanced the adolescents' sexual experiences were, the more commonly they reported differing experiences of sexual harassment. These associations were particularly strong among the girls. Among the sexually active adolescents, the more partners the adolescents had for intercourse, the more commonly they reported experiences of sexual harassment. Adolescents actively interested in romantic and sexual relationships may socialize in contexts where sexual harassment is more likely to occur. They may be more sensitive to sexual cues than their non-interested peers, or sexual harassment may be a traumatic experience predisposing adolescents to risk-taking sexual behavior as a form of acting out. A double standard regarding the appropriate expression of sexuality received some support in our data.

Perceived rather than actual overweight is associated with mental health problems in adolescence.

BACKGROUND: Overweight and perceived overweight are common among adolescents. The nature of the relationship between overweight/perceived overweight and mental health problems is still unclear. AIMS: The aim of this study was to examine whether actual overweight, perceived overweight or both are associated with internalizing and externalizing disorders among adolescents. METHODS: Data were collected by two similar school surveys in all Finnish-speaking secondary schools in Tampere (population 200,000) in the academic years 2002-2003 and 2012-2013. A total of 2775 acceptable responses were received. All the analyses were carried out separately for girls and boys. Mean age of the respondents was 15.6 years. RESULTS: In multivariate analyses perceived overweight, not actual weight, was significantly associated with higher risk of self-reported depression (OR: 4.3, 95% CI: 2.9-6.3, p < .001) and self-reported conduct disorder (OR: 2.3, 95% CI: 1.6-3.3, p < .001) in girls and with higher risk of self-reported depression (OR: 3.26, 95% CI: 1.65-6.4, p = .001) and self-reported social phobia (OR: 2.4, 95% CI: 1.0-5.6, p = .05) in boys. CONCLUSION: Perceived overweight rather than actual weight status is associated with both internalizing and externalizing mental health problems in adolescents.

Social phobia, depression and eating disorders during middle adolescence: longitudinal associations and treatment seeking.

BACKGROUND: Longitudinal associations between social phobia (SP), depression and eating disorders (EDs), and the impact of antecedent SP and depression on subsequent treatment seeking for EDs have rarely been explored in prospective adolescent population studies. AIM: We aimed to examine these associations in a large-scale follow-up study among middle adolescents. METHOD: We surveyed 3278 Finnish adolescents with a mean age of 15 years for these disorders. Two years later, 2070 were reached and again surveyed for psychopathology and treatment seeking. Longitudinal associations between the self-reported disorders and treatment-seeking patterns for self-acknowledged ED symptoms were examined in multivariate analyses, controlling for SP/depression comorbidity and relevant socioeconomic covariates. RESULTS: Self-reported anorexia nervosa (AN) at age 15 years predicted self-reported depression at age 17 years. Furthermore, self-reported SP at age 15 years predicted not seeking treatment for bulimia nervosa (BN) symptoms, while self-reported depression at age 15 years predicted not seeking treatment for AN symptoms during the follow-up period. CONCLUSIONS: Adolescents with AN should be monitored for subsequent depression. Barriers caused by SP to help seeking for BN, and by depression for AN, should be acknowledged by healthcare professionals who encounter socially anxious and depressive adolescents, especially when they present with eating problems.

Delinquency and sexual experiences across adolescence: does depression play a role?

PURPOSE: To elucidate a possible connection between delinquency and adolescent sexual behaviours in different age groups from 14 to 20 and the role of depression therein. MATERIALS AND METHODS: Data were gathered from the cross-sectional Finnish School Health Promotion Study 2010 and 2011 with 186,632 respondents. We first examined the bivariate relationship between delinquency and sexual behaviour, and then proceeded to multivariate models accounting for self-reported depression. Analyses were conducted separately for girls and boys, in seven age groups. The main outcomes were analysed by χ2 test and logistic regression. RESULTS: Delinquency was connected to having experienced sexual intercourse across all age groups, and was related to reporting multiple sexual partners among sexually active adolescents, in both boys and girls, before and after controlling for depression. Delinquency and depression were independently associated with the sexual behaviours studied. CONCLUSIONS: Being sexually active and engaging in risky sexual behaviours are related to delinquency in the adolescent population throughout the developmental phase, even in late adolescence when being sexually active is developmentally normative. Being sexually active is further connected to depression until middle adolescence, and risky sexual behaviours across adolescence. Clinicians working with adolescents presenting with delinquent behaviour with or without depression need to address their sexual health needs.

Mortality of young offenders: a national register-based follow-up study of 15- to 19-year-old Finnish delinquents referred for forensic psychiatric examination between 1980 and 2010.

BACKGROUND: The mortality rate of young offenders is high. Furthermore, mortality in young offenders is associated with psychiatric and substance use disorders. The primary aim of this national register-based follow-up study was to investigate the mortality rate of Finnish delinquents who underwent a forensic psychiatric examination between 1980 and 2010. As delinquency is not a solid entity, we further aimed to compare the risk of premature death among different subgroups of the delinquents; violent versus non-violent offenders, offenders with alcohol use disorders versus those with no such diagnoses, offenders with schizophrenia spectrum disorders versus conduct- and personality-disordered offenders, under-aged versus young adult offenders, and, finally, boys versus girls. METHODS: We collected the forensic psychiatric examination reports of all 15- to 19-year-old offenders who were born in Finland and had undergone the examination between 1.1.1980 and 31.12.2010 (n = 606) from the archives of the National Institute of Health and Welfare and retrospectively reviewed them. For each delinquent, four age-, gender- and place of birth-matched controls were randomly selected from the Central Population Register (n = 2424). The delinquents and their controls were followed until the end of 2015. The median follow-up time was 23.9 years (interquartile range 15.3-29.5). We obtained the mortality data from the causes of death register. Deaths attributable to a disease or an occupational disease were considered natural, and those attributable to an accident, suicide or homicide were considered unnatural. RESULTS: By the end of the follow-up period, 22.1% (n = 134) of the delinquents and 3.4% (n = 82) of their controls had died (OR 8.11, 95% CI 6.05-10.86, p < 0.001). Among boys, 22.0% (n = 121) of the delinquents and 3.7% (n = 81) of the controls had died (OR 7.38, 95% CI 5.46-9.95, p < 0.001). Male delinquents' risk of unnatural death was almost 11-fold, of natural death more than twofold, and of unclear death more than fourfold compared to that of their controls. No girls had natural or unclear deaths, but 23.6% (n = 13) of the delinquents and 0.5% (n = 1) of the controls had died due to unnatural causes (OR 67.79, 95% CI 8.63-532.00, p < 0.001). The violent delinquents' risk of premature death was twice that of the non-violent delinquents. The other comparisons demonstrated no statistically significant differences between subgroups. CONCLUSIONS: Even though the Finnish correction system prefers psychiatric treatment and rehabilitation over criminal sanctions, and the national health care system offers developmental-phase-specific psychiatric care, the mortality rate of delinquents, especially of those with a history of violent offences, is high. The excess mortality of offenders can be regarded as a specific public-health inequity that calls for more effective intervention procedures than those used thus far.

Current and recalled childhood gender identity in community youth in comparison to referred adolescents seeking sex reassignment.

We studied current (GIDYQ-A) and recalled (RCGI) childhood gender identity among 719 upper secondary school students 401 girls, mean age 17.0 (SD = 0.88) years old and 318 boys, mean age 17.2 (SD = 0.86 years old in Finland. We also compared these dimensions of identity in community youth to same dimensions among adolescent sex reassignment (SR) applicants. Most community youth scored high on the normative, cis-gender end of gender experience (median score 4.9 for boys and 4.9 for girls) and recalled fairly gender typical childhood behaviours and experiences. The girls displayed more gender non-conformity in childhood. Among the boys 2.2% and among the girls 0.5% displayed potentially clinically significant gender dysphoria on the GIDYQ-A. The community youth differed clearly from adolescent SR applicants on current and recalled childhood gender identity (SR applicants were 47, 6 natal boys and 41 natal girls, average ages were 16.4 years old (SD = 0.93) and girls were on average 16.8 years old (SD = 1.0).

Self-rated psychopathic traits in a sample of treatment-seeking adolescent girls with internalizing and externalizing disorders: comparisons to girls in the community.

BACKGROUND: Psychopathy research has thus far focused mostly on child, male, and delinquent samples, but the results are most likely non-generalizable to adolescent girls with mental health disorders. AIM: The present study aimed to compare self-rated psychopathic traits between female psychiatric outpatients and girls in the community, and to investigate how psychopathic traits relate to psychiatric disorders. METHOD: The outpatient sample comprised 163 girls aged 15-17-years recruited from municipal mental health services. Psychiatric diagnoses were assessed based on the ICD-10 classification. The community sample comprised 355 girls from secondary, vocational, and high schools. The Youth Psychopathic trait Inventory (YPI) served as a self-assessment tool. RESULTS: Treatment-seeking girls exhibit a more impulsive and irresponsible lifestyle than do girls in the community. Girls with externalizing psychopathology, unlike those with an internalizing disorder, exhibit more deficient affective experience than do girls in the community. Psychopathic traits associate with having a psychiatric disorder, a depressive disorder, ADHD, and a conduct disorder. CONCLUSIONS: The psychiatric examination of treatment-seeking adolescent girls would likely benefit from screening for psychopathy and its underlying components.

Trends in Alcohol Use among Adolescents from 2000 to 2011: The Role of Socioeconomic Status and Depression.

AIMS: To assess temporal trends of adolescent alcohol use in Finland from 2000 to 2011, according to socio-economic status and depression. METHODS: Classroom self-administered questionnaires concerning health, health behaviours and school experiences were administered biennially from 2000-2001 to 2010-2011 to nationwide samples of 14- to 16-year-olds (n = 618,084). Alcohol use was measured as the frequencies of drinking and drunkenness. Socioeconomic status was measured using parental education and unemployment. Depression was measured using a Finnish modification of the Beck Depression Inventory. Cross-tabulations and a logistic regression analysis were applied. RESULTS: Over the study period, rates of frequent drinking and frequent drunkenness decreased among both boys and girls. Low levels of parental education and unemployment as well as adolescent depression increased the likelihoods of frequent drinking and drunkenness. Unlike the general decreasing trend observed for alcohol use, the likelihoods of frequent drinking and drunkenness increased among adolescents who were depressed and had unemployed parents with low levels of education. The prevalence of frequent drunkenness was 75.8% among the boys in this group during 2008-2011, whereas the corresponding prevalence was 2.3% for boys without depression and with highly educated, employed parents. The corresponding figures for girls were 41.7% and 1.4%, respectively. CONCLUSIONS: The overall decreasing trend in frequent alcohol use was not observed among socioeconomically deprived adolescents with depression. Thus, alcohol prevention programmes should treat these youth as special targets.

Are eating disorders and their symptoms increasing in prevalence among adolescent population?

BACKGROUND: A debate concerns whether eating disorders are increasing in prevalence. The role of socio-economic status (SES) for adolescent eating disorders (ED) is another matter of debate. AIMS: To ascertain whether self-reported eating disorders or their symptoms have increased in prevalence in adolescent population from the early 2000s to early 2010s. METHODS: A person-identifiable classroom survey, Adolescent Mental Health Cohort study, was carried out among the 9th graders in comprehensive schools in Tampere, Finland, during academic year 2002-2003, and replicated among then 9th graders during academic years 2012-2013. Eating disorders were elicited with questionnaires tailored according to DSM-IV criteria for anorexia nervosa and bulimia nervosa. RESULTS: No changes were observed between 2002-2003 and 2012-2013 in the prevalence of anorexia and bulimia, most of the symptoms of anorexia and bulimia, or the proportion of adolescents having received treatment due to eating disorders among the girls or the boys. Eating disorders, treatment contacts due to eating disorders, and eating disorder symptoms were not systematically associated with either low or high parental socio-economic status. CONCLUSION: Based on this dataset, eating disorders are not increasing in the adolescent population. Adolescent eating disorders are not associated with socio-economic status of their family.

Self-assessed limited prosocial emotions do not distinguish community youth with psychosocial problems from those without them.

BACKGROUND: In DSM 5, conduct disorder was expanded with the new specifier 'with limited prosocial emotions (LPE)'. These callous-unemotional traits have been emphasized as the 'core' of psychopathy syndrome providing greater information about current and future impairment. Individuals with callous-unemotional traits have shown elevated levels of impairment, and these traits have been suggested to serve as a useful indicator for psychiatric vulnerability and psychosocial maladjustment also among community youth. AIM: The aim of this study was to investigate the prevalence of LPE in a sample of Finnish mid-adolescent community youth, and to determine whether adolescents with and without LPE differ from each other in general psychopathology. METHODS: A classroom survey was conducted among 9th graders at secondary schools (n = 446). The Antisocial Process Screening Device-Self-Report (APSD-SR) was used to assess LPE. The adolescents' general psychopathology was assessed using the Youth Self Report (YSR). RESULTS: Almost 10% of the adolescents met the criteria for LPE. Youth with LPE did not differ significantly from those without LPE on the Total Problems Score or on externalizing psychopathology. Only one statistically significant difference emerged in group comparisons; adolescents with LPE scored significantly lower on somatic complaints than their counterparts without LPE. CONCLUSIONS: LPE are a common phenomenon among community youth, and the specifier-as measured with a self-assessment-does not distinguish adolescents with psychosocial problems from those without them. More research is obviously needed to elucidate the role of LPE in juveniles.