[Suicidality in adolescents with therapy refractory internalising behaviour]. / Suïcidaliteit bij adolescenten met therapieresistente internaliserende problematiek.

BACKGROUND: Suicidality in adolescence is increasingly becoming a societal problem, especially because there remains a small group of patients in which treatment effectiveness is small. Existing formal guidelines often are of limited value in this group that often shows complex comorbidity.
AIM: To contribute to the diagnostic and aetiological perspective in order to better understand therapy refractory internalising behaviour.
METHOD: Integration of several scientific theoretical concepts into a holistic model.
RESULTS: Evidence shows that suicidality should be considered within a broader scope of therapy refractory internalising behaviour. Important underpinnings comprise a partially overprotective parenting style, disturbed attachment processes and social anxiety. Internalising and externalising behaviour problems are viewed as expressions of avoidance behaviour. Furthermore, we discuss important implications for treatment.
CONCLUSION: Applying an aetiological model for therapy refractory internalising behaviour may help to increase efficacy of treatment. Thus, transdiagnostic treatment can be offered, being less dependent on specific dsm-classifications. Focus of treatment is on restoration of basic trust between the youngster and his parents, and on ending avoidance behaviour that is based on social anxiety.

Saliva oxytocin, cortisol, and testosterone levels in adolescent boys with autism spectrum disorder, oppositional defiant disorder/conduct disorder and typically developing individuals.

The aim of the current study was to compare levels of oxytocin, cortisol, and testosterone in adolescents with either autism spectrum disorder (ASD), or oppositional defiant disorder (ODD)/conduct disorder (CD), and in typically developing individuals (TDI), and relate hormone levels to severity and subtype of aggression and callous-unemotional (CU) traits. Saliva concentrations of oxytocin, cortisol, and testosterone were assessed in 114 male participants (N = 49 ASD, N = 37 ODD/CD, N = 28 TDI,) aged 12-19 years (M = 15.4 years, SD = 1.9). The ASD and the ODD/CD groups had significantly lower levels of oxytocin than the TDI group, and the ODD/CD group had significantly higher levels of testosterone than the ASD group. There were no group effects on cortisol levels. Group differences remained for oxytocin after correcting for the influence of CU traits, but were not significant after controlling for aggression. Results for testosterone became non-significant after correction for either CU traits or aggression. Across groups, higher levels of CU traits were related to higher levels of cortisol and testosterone, however, proactive and reactive aggression were unrelated to all three hormonal levels. The current findings show that, regardless of cognitive ability or comorbid disorders, the diagnostic groups (ASD, ODD/CD) differ from each other by their hormonal levels, with the ASD group characterized by relative low level of oxytocin, and the ODD/CD group by a relative low level of oxytocin and high level of testosterone. These group effects were partly driven by differences in CU traits between the groups.