Biocognitive Classification of Antisocial Individuals Without Explanatory Reductionism.

Effective and specifically targeted social and therapeutic responses for antisocial personality disorders and psychopathy are scarce. Some authors maintain that this scarcity should be overcome by revising current syndrome-based classifications of these conditions and devising better biocognitive classifications of antisocial individuals. The inspiration for the latter classifications has been embedded in the Research Domain Criteria (RDoC) approach. RDoC-type approaches to psychiatric research aim at transforming diagnosis, provide valid measures of disorders, aid clinical practice, and improve health outcomes by integrating the data on the genetic, neural, cognitive, and affective systems underlying psychiatric conditions. In the first part of the article, we discuss the benefits of such approaches compared with the dominant syndrome-based approaches and review recent attempts at building biocognitive classifications of antisocial individuals. Other researchers, however, have objected that biocognitive approaches in psychiatry are committed to an untenable form of explanatory reductionism. Explanatory reductionism is the view that psychological disorders can be exclusively categorized and explained in terms of their biological causes. In the second part of the article, we argue that RDoC-like approaches need not be associated with explanatory reductionism. Moreover, we argue how this is the case for a specific biocognitive approach to classifying antisocial individuals.

"Frank" presentations as a novel research construct and element of diagnostic decision-making in autism spectrum disorder.

Many individuals with ASD have a distinctive behavioral presentation that is recognizable within moments, a phenomenon we call "frank" ASD. This phenomenon has been discussed informally for decades, perhaps as "classic" ASD; however, there is no unitary "classic" presentation, and classic autism does not seem to correspond to level of functioning. Thus, neither "frank" nor "classic" autism has been delineated or studied as a research construct. To initiate the empirical study of frank ASD, we surveyed 151 clinicians, from a range of disciplines that diagnose ASD, about this phenomenon. Respondents completed a 13-item questionnaire about frank ASD, which was analyzed using a mixed-methods approach. Ninety-seven percentage of respondents were familiar with the phenomenon. Respondents estimated that 40% of the ASD population has a frank presentation. Respondents reported the most highly specific behaviors associated with frank presentations were a general sense of impaired reciprocity, quality of eye contact, atypical vocal prosody, presence of motor mannerisms, and atypical gait or posture. In general, respondents reported detecting frank features rapidly, with the majority forming their impressions within the first ten minutes of interaction or observation. Although unstudied empirically, "frank" presentations of ASD are familiar to diagnosing clinicians, and appear to be based on behaviors both central to ASD diagnostic criteria (e.g., impaired reciprocity), and absent from diagnostic criteria (e.g., atypical gait or posture). We discuss these findings within the context of diagnostic decision-making and behavioral phenotyping of ASD. Autism Res 2016,. © 2016 International Society for Autism Research, Wiley Periodicals, Inc. Autism Res 2017, 10: 653-662. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.

Developing a classification system of social communication functioning of preschool children with autism spectrum disorder.

AIM: Impairments in social communication are the hallmark of autism spectrum disorder (ASD). Operationalizing 'severity' in ASD has been challenging; thus, stratifying by functioning has not been possible. The purpose of this study is to describe the development of the Autism Classification System of Functioning: Social Communication (ACSF:SC) and to evaluate its consistency within and between parent and professional ratings. METHOD: (1) ACSF:SC development based on focus groups and surveys involving parents, educators, and clinicians familiar with preschoolers with ASD; and (2) evaluation of the intra- and interrater agreement of the ACSF:SC using weighted kappa (кw ). RESULTS: Seventy-six participants were involved in the development process. Core characteristics of social communication were ascertained: communicative intent; communicative skills and reciprocity; and impact of environment. Five ACSF:SC levels were created and content-validated across participants. Best capacity and typical performance agreement ratings varied as follows: intrarater agreement on 41 children was кw =0.61 to 0.69 for parents, and кw =0.71 to 0.95 for professionals; interrater agreement between professionals was кw =0.47 to 0.61, and between parents and professionals was кw =0.33 to 0.53. INTERPRETATION: Perspectives from parents and professionals informed ACSF:SC development, providing common descriptions of the levels of everyday communicative abilities of children with ASD to complement the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Rater agreement demonstrates that the ACSF:SC can be used with acceptable consistency compared with other functional classification systems.

[Establishing a team-scoring model for socio-emotional development of patients with intellectual disabilities]. / Etablierung eines Modells zur Beurteilung der sozioemotionalen Entwicklung bei Menschen mit geistiger Behinderung in ein Team.

OBJECTIVES: We know from daily experience in the care of people with intellectual disabilities that the usually applied bio-psycho-social model is not sufficient in the psychiatric treatment of that patient-group. A fourth dimension considering cognitive and socio-emotional development should be added. A specific algorithm for evaluating the emotional level of a person (called "SEO") has demonstrated its effectiveness. Aim of this study is to test its feasibility in everyday practice in a hospital team of a psychiatric ward. METHODS: The SEO was used to evaluate 18 patients with intellectual disability by a multi-professional team in a psychiatric hospital ward. The time for completing the SEO was measured within a time period of 8 weeks. Additionally, the influence on patients' problem behaviour in the time period after completion of the SEO was measured. RESULTS: The average time needed for completing one SEO was 11 minutes. After the second week, there was no further shortening of the time necessary for completion of the SEO, nor was their any further improvement in the quality of scoring the SEO by the team. After completion of the SEO, behavioral problems of the patients improved significantly in the following time period. CONCLUSION: The SEO seems to be time-economic and feasible for evaluating the socio-emotional development, which can be well integrated in the routine of a psychiatric hospital team. The benefit for patients is the significant reduction of problem behaviour after SEO-evaluation in general.

[Inter-rater reliability and construct validity of the OPD-CA axis structure: first study results regarding the integration of OPD-CA into clinical practice]. / Interrater-reliabilität und Konstruktvalidität der OPD-KJ-Achse Struktur--Erste Forschungsergebnisse zum Einsatz der OPD-KJ im Rahmen der klinischen Routine.

The axis structure of the Operationalized Psychodynamic Diagnostics in childhood and adolescence (OPD-CA) has proven to be a reliable and valid diagnostic tool under research conditions. However, corresponding data regarding the integration of OPD-CA axis structure into clinical practice is still lacking. Hence, this aspect was examined as part of a randomized controlled clinical trial realized at Asklepios Fachklinikum Tiefenbrunn. Here, the OPD-CA axis structure has been applied to assess the structural level of 42 adolescent patients (15-19 years). In contrast to previous studies, the assessment was not carried out by independent raters using a videotaped OPD-CA interview, but the rating was part of clinical routine procedures. Also under these conditions, inter-rater reliability was high, in particular regarding the four subscales of the OPD-CA axis structure. With respect to construct validity, the results of our study supported a two-factor solution, which is in accordance with the findings of two previous works. One factor corresponded to the dimension "self-regulation" while the other factor included both the dimension "self-perception and object perception" as well as the dimension "communication skills". Implications of the findings for research and practice are discussed.

Internet e o risco da desmedida / Internet and the risk of lack of limits

O presente trabalho visa discutir o uso da internet na sociedade atual em diferentes contextos. A dependência de internet é definida e a complexidade desses diagnósticos é explicitada, sendo apresentadas outras dependências comportamentais que podem ser agravadas pelo uso da rede. A dificuldade em discriminar uso criativo, uso de risco e dependência de internet é discutida à luz de características da sociedade contemporânea. Implicações do uso da internet no estilo de vida e na qualidade das relações são apontadas. Com a pluralidade de possibilidades trazidas pela tecnologia, surge o desafio de usar esses recursos para propiciar encontros verdadeiros, dar subsídios para escolhas genuínas, viabilizar a expressão da singularidade de cada um. O uso criativo favorece o processo de individuação, o defensivo, a alienação.

The aim of this paper is to discuss internet use in present society considering different contexts. Internet addiction is defined, the complexity of this diagnosis is presented and other behavioral addictions that can be aggravated by internet are described. Difficulty in differentiating creative use, use of risk and addiction is discussed in light of contemporary society. Implications of internet in lifestyle and in the quality of the relations are pointed out. Along with the plurality of possibilities brought by technology comes the challenge of using this resources to intermediate true encounters, to colaborate to genuine choices and to facilitate the expression of each one's singularity. The creative use contributes to the individuation process whereas the defensive one leads to alienation.

Internet e o risco da desmedida / Internet and the risk of lack of limits

O presente trabalho visa discutir o uso da internet na sociedade atual em diferentes contextos. A dependência de internet é definida e a complexidade desses diagnósticos é explicitada, sendo apresentadas outras dependências comportamentais que podem ser agravadas pelo uso da rede. A dificuldade em discriminar uso criativo, uso de risco e dependência de internet é discutida à luz de características da sociedade contemporânea. Implicações do uso da internet no estilo de vida e na qualidade das relações são apontadas. Com a pluralidade de possibilidades trazidas pela tecnologia, surge o desafio de usar esses recursos para propiciar encontros verdadeiros, dar subsídios para escolhas genuínas, viabilizar a expressão da singularidade de cada um. O uso criativo favorece o processo de individuação, o defensivo, a alienação. (AU)

The aim of this paper is to discuss internet use in present society considering different contexts. Internet addiction is defined, the complexity of this diagnosis is presented and other behavioral addictions that can be aggravated by internet are described. Difficulty in differentiating creative use, use of risk and addiction is discussed in light of contemporary society. Implications of internet in lifestyle and in the quality of the relations are pointed out. Along with the plurality of possibilities brought by technology comes the challenge of using this resources to intermediate true encounters, to colaborate to genuine choices and to facilitate the expression of each one's singularity. The creative use contributes to the individuation process whereas the defensive one leads to alienation. (AU)

Problem behaviours of middle school students in eastern China and its associated factors.

OBJECTIVE: To investigate the problem behaviours of middle school students and its associated factors in Anhui province of China, and to provide a theoretical basis for promoting early health education. METHODS: A cross-sectional survey was conducted and 4235 middle school students were measured by Prediction Test of Problem Children, Family Environment Scale - Chinese Version, Simple Coping Style Questionnaire, Psychological Sense of School Membership and general state questionnaire. RESULTS: The prevalence of problem behaviours in our sample was 4.5%. Using binary logistic regression analysis, we found that family environment, school belonging, coping style, relationship with mother and classmate relationship were associated with problem behaviours of middle school students. CONCLUSIONS: Poor family environment, poor sense of school belonging, passive acting style were significantly correlated with problem behaviours. There is an urgent need to improve problem behaviours through collaboration among families, schools and society.

[Conduct disorder - is there an evidence base for classification and treatment?]. / Störungen des Sozialverhaltens. Sind neue Erklärungsansätze eine Grundlage für eine evidenzbasierte Klassifikation und Behandlung?

This article concerns whether present psychiatric criteria for conduct disorder have sufficient predictive validity. Recent neurobiological findings are briefly summarized which suggest a more specific phenotyping of the early starter subtype of conduct disorder on the basis of neurobiological and personality correlates. Findings are discussed concerning deficits in neurobiological functioning with regard to emotion perception and emotion regulation relevant to social and aggressive behaviour as well as possible mediating influences of early psychosocial experiences on the development of neurobiological functions. The clinical implications for the classification, course and therapy of conduct disorders are also considered.

Asperger's syndrome and high-functioning autism: language, motor and cognitive profiles.

The objective of this study is to compare the cognitive profile, the motor and language functioning and the psychosocial adaptation of children with Asperger syndrome (AS) and with high-functioning autism (HFA). Subjects were recruited through the department Autism and Developmental Disorders of the Heckscher-Klinikum. To be included in the study, the full-scale-IQ had to be at least 80. Subjects with AS had to have a normal early language development and subjects with HFA a clear delay in language development, as reported by their parents. The sample consisted of 57 children with Asperger syndrome and 55 children with high-functioning autism. The mean age of the children was 10 years. All subjects were examined with a standardised test battery. Children with AS had a higher full-scale-IQ than children with HFA. This was due to a higher verbal-IQ. There were no significant differences in the performance-IQ. At a mean age of 10 years, subjects with AS had better language skills than subjects with HFA, but at least 30% showed clear receptive language problems. Motor problems were present in about 50% of the children with AS and HFA. The level of psychosocial adaptation was clearly reduced, but was comparable for the two groups. The differences in verbal-IQ and language skills between the two groups could be explained through the definition of the syndromes. The presence of language problems in the subjects with AS at age 10, the comparable degree of motor impairment and level of psychosocial adaptation question the validity of the distinction between AS and HFA within the category of pervasive developmental disorders.

Prevalence of intellectual disabilities in Norway: Domestic variance.

Based on national registers, the prevalence of intellectual disability (ID) in Norway is estimated to be 0.44 per 100 inhabitants. This study aimed to examine geographic and urban-rural differences in the prevalence of ID in Norway. Methods A survey based on the national register. Financial transfers intended to provide equal services to people with ID are based on these reports. Results A higher prevalence was found in the North region of Norway. A negative correlation between the population density and the prevalence of ID was also found. Conclusion There was considerable geographic and urban-rural differences in the prevalence of ID, which may be attributable to not only the large diversity of services, but also some other factors. The results were discussed with respect to the deinstitutionalisation progress, resource-intensive services and costs. Differences also reflect some problems in diagnosing ID in people having mild ID.

Refinements in the hierarchical structure of externalizing psychiatric disorders: Patterns of lifetime liability from mid-adolescence through early adulthood.

Research on hierarchical modeling of psychopathology has frequently identified 2 higher order latent factors, internalizing and externalizing. When based on the comorbidity of psychiatric diagnoses, the externalizing domain has usually been modeled as a single latent factor. Multivariate studies of externalizing symptom features, however, suggest multidimensionality. To address this apparent contradiction, confirmatory factor analytic methods and information-theoretic criteria were used to evaluate 4 theoretically plausible measurement models based on lifetime comorbidity patterns of 7 putative externalizing disorders. Diagnostic information was collected at 4 assessment waves from an age-based cohort of 816 persons between the ages of 14 and 33. A 2-factor model that distinguished oppositional behavior disorders (attention-deficit/hyperactivity disorder, oppositional defiant disorder) from social norm violation disorders (conduct disorder, adult antisocial behavior, alcohol use disorder, cannabis use disorder, hard drug use disorder) demonstrated consistently good fit and superior approximating abilities. Analyses of psychosocial outcomes measured at the last assessment wave supported the validity of this 2-factor model. Implications of this research for the theoretical understanding of domain-related disorders and the organization of classification systems are discussed.

Development and validation of the Subtypes of Antisocial Behavior Questionnaire.

There is converging evidence that physical aggression, rule-breaking, and social aggression constitute meaningfully distinct, if somewhat overlapping, components of the broader construct of antisocial behavior. Indeed, these subtypes appear to have different developmental trajectories, demographic correlates, and personological underpinnings. They also demonstrate important etiological distinctions. One potential limitation to accumulating additional scientific insights into the correlates and origins of these three types of antisocial behavior is the lack of an efficient self-report assessment in the public domain. We developed the 32-item Subtypes of Antisocial Behavior Questionnaire (STAB) to fill this gap. Our goal was to develop a brief measure that could reliably and validly assess each of the three major subtypes of antisocial behavior and that would be freely available for other researchers. The present series of studies provides initial evidence of the factorial validity, internal consistency, and criterion-related validity of the STAB scales. In short, it appears that the STAB is a brief and useful measure that can be used to differentiate and assess physically aggressive, rule-breaking, and socially aggressive forms of antisocial behavior.

[Disorders of socialization in children and adolescents].

UNLABELLED: According to psychiatric classification, problems in effective socialization adjustment are characteristic of Pervasive Developmental Disorder (PDD), autism and Asperger syndromes. However, working in a clinic divulges a significantly sizable section of the population that faces problems in social functioning but does not fit either of the two aforementioned psychiatric diagnoses. Over the years a number of informal diagnoses have been developed for this group. The current literature reviews these diagnoses and deals with the question of whether these diagnoses are indeed different or whether they constitute a different viewpoint of the same problem. Some authors claim that the scarcity of current knowledge makes it impossible to provide a proper and precise answer. Therefore, the correct and effective approach is to integrate all the different viewpoints. Such an integrative approach may assist in better understanding the developmental socializing difficulties at a later time. In attempting to characterize the developmental socializing difficulties beyond the mere diagnoses, three major research viewpoints were developed while studying this group: the biological viewpoint, the missing central viewpoint and the behavioral viewpoint. CONCLUSIONS: It is important for the primary treating physician to show vigilance with regard to symptoms of impaired social functioning, especially in children and adolescents.

Can progressive and non-progressive behavioural variant frontotemporal dementia be distinguished at presentation?

BACKGROUND: Recent findings suggest that patients with behavioural variant frontotemporal dementia (bv-FTD) differ in their disease progression (progressive vs non-progressive patients). The current study investigates whether the two groups can be discriminated by their clinical features at first presentation. METHODS: Archival clinical data of the Early Onset Dementia Clinic, Cambridge, UK, were analysed for 71 patients with bv-FTD: 45 progressive and 26 non-progressive cases with more than 3 years of follow-up. RESULTS: The subgroups were largely indistinguishable on the basis of the presenting clinical features but could be distinguished on general cognitive (Addenbrooke's Cognitive Examination-revised) and selected supportive diagnostic features (distractibility, stereotypic speech, impaired activities of daily living (ADLs) and current depression). CONCLUSIONS: Progressive and non-progressive patients are difficult to differentiate on the basis of current clinical diagnostic criteria for FTD but a combination of general cognitive, executive dysfunction and impaired ADL measures appear to be the most promising discriminators.

A comparison of four scoring methods based on the parent-rated Strengths and Difficulties Questionnaire as used in the Dutch preventive child health care system.

BACKGROUND: Validated questionnaires can support the identification of psychosocial problems by the Preventive Child Health Care (PCH) system. This study assesses the validity and added value of four scoring methods used with the Strengths and Difficulties Questionnaire (SDQ) for the identification of psychosocial problems among children aged 7-12 by the PCH. METHODS: We included 711 (of 814) children (response: 87%) aged 7-12 undergoing routine health assessments in nine PCH services across the Netherlands. Child health professionals interviewed and examined children and parents. Prior to the interview, parents completed the SDQ and the Child Behaviour Checklist (CBCL), which were not shown to the professionals. The CBCL and data about the child's current treatment status were used as criteria for the validity of the SDQ. We used four SDQ scoring approaches: an elevated SDQ Total Difficulties Score (TDS), parent-defined difficulties, an elevated score for emotional symptoms, conduct problems or hyperactivity in combination with a high impairment score, and a combined score: an elevated score for any of these three methods. RESULTS: The Cohen's Kappa ranged from 0.33 to 0.64 for the four scoring methods with the CBCL scores and treatment status, generally indicating a moderate to good agreement. All four methods added significantly to the identification of problems by the PCH. Classification based on the TDS yielded results similar to more complicated methods. CONCLUSION: The SDQ is a valid tool for the identification of psychosocial problems by PCH. As a first step, the use of a simple classification based on the SDQ TDS is recommended.

A latent variable modeling approach to identifying subtypes of serious and violent female juvenile offenders.

Females have recently become an important population in research related to serious and violent juvenile offending. Although a small body of research exists on girls in the deep end of the system, very few studies have examined the degree of heterogeneity within high-risk female samples. This study applied latent class analysis (LCA) to identify subgroups of female juvenile offenders based on their self-report of offending profiles (N=133). Results supported a three-class solution with subgroups characterized by patterns of 'violent and delinquent', 'delinquency only', and 'low' offending patterns. The LCA solution was replicated in an independent sample of high-risk females. The 'violent and delinquent' class was characterized by significantly higher rates of DSM-IV diagnoses for internalizing disorders, affect dysregulation, exposure to violence (within the home, school and neighborhood), and familial histories of criminality. Implications for future research, policy and clinical practice are discussed.