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Background: The failure to regulate emotions, namely emotional dysregulation (ED), is a relevant construct in adolescent psychiatry, in terms of prognostic and developmental implications. We developed and validated a novel self-report questionnaire for the assessment of ED, the RIPoSt-Y, both in clinical and non-clinical samples.Methods: Items selection and subscales construction were conducted on healthy controls (n=374), while test-retest reliability was evaluated in a subsample (n=72); internal consistency was examined both in the control group and in two clinical samples, respectively including patients with Bipolar Spectrum Disorders (BSD; n=44) and ADHD (n=34). Construct, concurrent and convergent validity were also assessed.Results: Thirty-one items were finally retained, and three subscales were identified (Affective Instability, Emotional Reactivity, Interpersonal Sensitivity). Test-retest was significant for each subscale with moderate-to-good correlations, and internal consistency showed good-to-excellent coefficients. Construct validity was supported by significant differences between patients and controls and gender-related differences. Concurrent validity was confirmed through significant associations with two subscales of the CHT-Q, while convergent validity proved to be significant with the CBCL/YSR dysregulation-profile. Cut-offs were also computed to discriminate clinically significant scores of ED.Limitations: The use of a school-based survey to recruit controls could have biased our results; gender distributions between clinical and non-clinical samples were significantly different.Conclusions: Our novel questionnaire proved to be a valid and reliable tool able to assess the presence of ED in youths and to characterize this fundamental construct in its multidimensional facets. [ABSTRACT FROM AUTHOR]

To systematically investigate if there is a significant association between markers of autonomic functioning and emotional dysregulation (ED) in children and adolescents. Based on a preregistered protocol (PROSPERO: CRD42021239635), PubMed, Web of Knowledge/Science, Ovid MEDLINE, Embase, and APA PsycInfo databases were searched until April 21, 2021, to identify empirical studies reporting indices of autonomic nervous system (ANS) functioning in youths meeting DSM (version III, IV, IV-TR, 5 or 5-TR) or International Classification of Diseases (ICD) (version 9 or 10) criteria for any psychopathological/neurodevelopmental condition and assessed for ED with a validated scale. Eligible outcomes included correlation coefficients between ED and ANS measures or differences in ANS measures between youths with and without ED. Study quality was assessed with the Appraisal tool for Cross-Sectional Studies (AXIS) and the Newcastle-Ottawa Scale (NOS) for cohort studies. Random-effects meta-analyses were used for data synthesis. There were 12 studies (1,016 participants) included in the descriptive review and 9 studies (567 participants) included in the meta-analyses. No evidence of a significant association between ED and altered cardiac or electrodermal functioning was found. However, exploratory meta-regressions suggested a possible association between reduced resting-state cardiac vagal control and increased ED. This study did not find evidence of an association between ED and autonomic dysfunction. However, preliminary evidence that reduced vagal control at rest might be a transdiagnostic marker of ED in young people was found. Additional studies comparing autonomic measures in youths with and without ED are needed and should also assess the effects of interventions for ED on ANS functioning. Systematic Review and Meta-Analysis: Is Autonomic Nervous System Functioning Atypical in Children and Adolescents With Emotional Dysregulation? https://www.crd.york.ac.uk/prospero/ ; CRD42021239635. [ABSTRACT FROM AUTHOR]

Objective Several studies suggested that in addition to child-driven factors (i.e., temperamental style), parenting behavior can, at least in part, influence the maintenance of Callous Unemotional (CU) traits in children; however, more information is needed to distinguish which styles (negative parenting or lack of positive parenting) predict increased levels of CU traits. The aim of the present treatment study was to examine which components of parenting are longitudinally associated with levels of CU traits in children with a disruptive behavior disorder diagnosis. Method The current study examined cross-lagged reciprocal effects models between positive and negative parenting practices, and the levels of child CU traits over three time points, including both positive and negative dimensions of parenting in the same model. Participants were 126 Italian children with diagnosis of disruptive behavior disorder (oppositional defiant disorder or conduct disorder), 113 boys and 13 girls, 110 Caucasian, 48 with conduct disorder, and 78 with oppositional defiant disorder, treated with a multi-component intervention, based on cognitive behavioral principles and practices. Participants were all 9–10 years of age at the beginning of the study, and were followed-up until the age of 11–12 years (24 months in total, the first 12 under treatment) using parent report (Alabama Parenting Questionnaire and Child Behavior Check List) and child report (Inventory of Callous-Unemotional Traits) measures. Results No significant cross-lagged path was found between negative parenting and CU traits; these two variables were also unrelated when positive parenting was considered in the same model. In contrast, reciprocal effects between positive parenting and CU were found: higher levels of positive parenting predicted lower levels of CU traits. Conclusions The current findings suggest that the positive dimension of parenting may need to be targeted in the treatment of DBD children with higher CU traits. [ABSTRACT FROM AUTHOR]

Deficits in emotional reactivity are frequently reported in Disruptive Behavior Disorders (DBDs). A deficit in prosocial emotions, namely the callous unemotional trait s (CU), may be a mediator of emotional reactivity. Our aim is to investigate subjective emotional reactivity towards visual stimuli with different affective valence in youth s with DBDs and healthy controls. The clinical sample included 62 youths with DBDs (51 males, 8 to 16 years, mean 11.3±2.1 years), the control group 53 subjects (36 males, 8 to 16 years, mean 10.8±1.5 years). The groups were compared using the Child Behavior Checklist (CBCL), the Inventory of Callous-Unemotional Traits (ICU), and the International Affective Picture System (IAPS), which explores the affective (pleasant/unpleasant emotional reaction) and arousal (low/high intensity of emotion) dimensions. The DBD group presented higher scores in externalizing and internalizing CBCL scores, and in ICU callous and indifferent subscales. At the IAPS, DBD patients differed from controls in the affective valence of the images, rating less unpleasant neutral and negative images. The CU traits were the only predictor of emotional reactivity in the DBD sample. A less aversive way to interpret neutral and negative stimuli may explain why DBD patients are less responsive to negative reinforcements. [ABSTRACT FROM AUTHOR]

Disruptive Behavior Disorders (DBDs) are among the most common reasons for youth referrals to mental health clinics. Aim of this study is to compare short and medium term efficacy of a multimodal treatment program (MTP), compared to community care (treatment-as-usual, TAU). The sample included 135 youths with DBDs (113 males, age range 9-15 years, mean age 12±2.5 years) were assigned either to a MTP (n=64), or addressed to community care for a TAU (n=71). Outcome measures were the Child Behaviour Checklist (CBCL) and the Children's Global Assessment Scale (C-GAS). All subjects were assessed at the baseline (T0), after 1-year treatment (T1) and after a 2-year follow-up (T2). Compared with patients receiving TAU, youths in the MTP showed, both at T1 and T2, significantly lower scores on CBCL Externalizing Scale, Internalizing Scale, Anxious/Depressed, Social Problems, and Aggressive Behavior, and higher scores at the C-GAS. Improvement in Internalizing Scales was particularly evident, with a shift from the clinical to the non-clinical range. Rate of use of mental health services and scholastic failure were reduced in the MTP. It is suggested that the improvement of the Internalizing symptoms is a crucial component of the therapeutic process in this MTP. [ABSTRACT FROM AUTHOR]

Objective: Predictors of poor response to treatments in youths with disruptive behavior disorders (DBDs), including conduct disorder (CD) and oppositional defiant disorder (ODD), are under-studied. Multimodal psychosocial interventions are the best option, but a significant portion of patients needs adjunctive pharmacotherapy. The concept of "psychopathy", and namely, the callous (lack of empathy and guilt) and unemotional (shallow emotions) trait, has been considered a possible specifier indicating a more severe subgroup of patients. We explored whether the callous-unemotional trait (CU) may affect the response to multimodal treatment in referred youths with DBDs. Method: 118 youths (102 males, age range 6-14 years, mean age 11.1 ± 2.5 years) completed a 12-month multimodal intervention, 48 of whom (41%) needed an associated pharmacotherapy. The patients were assessed according to psychopathological profile (Child Behavior Checklist, CBCL), severity and improvement (Clinical Global Impression-Severity and Improvement scores, CGI-S and CGI-I), functional impairment (Children-Global Assessment Scale, C-GAS), and psychopathic dimension (Antisocial Process Screening Device, APSD), including CU dimension. Results: 58 patients (49.2%) were non-responders. They had more frequently a diagnosis of CD than ODD, presented a comorbid mood disorder, higher CBCL scores in rule-breaking behavior, and higher APSD ("psychopathic") scores. Subjects with higher or lower CU differed only according to the rate of responders (35% vs. 60%, p b .05). The linear blockwise regression indicated that pre-treatment functional impairment (C-GAS) and baseline CU trait were predictors of non-response. The logistic regression indicated that only the value of baseline APSD-CU trait was a predictor of non-response. Conclusions: A careful assessment of baseline clinical functioning and psychopathological features, namely the psychopathic traits, can identify the most problematic patients, and has specific prognostic and treatment implications. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Studies on referred children and adolescents with conduct disorder (CD) have relevant implications for prevention and treatment. We addressed this issue in a large sample of youths with CD, considering age at onset, sex, and response to treatments as variables. Methods: The sample consisted of 198 patients (153 males and 45 females; age range, 8-18 years; mean age, 13.2 ± 2.6 years), consecutively diagnosed as having CD during a 5-year period. The diagnoses were based on fulfillment of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria, according to historical information, prolonged observations, and a clinical interview (Schedule for Affective Disorders and Schizophrenia for School-Age Children—Present and Lifetime Version). Three subtypes of aggressive behaviors—“predatory” (controlled, planned, and goal-oriented), “affective” (impulsive, explosive, and unprofitable), and “mixed” (with both the features)—were considered in this study. Results: Patients with prepubertal onset were younger at referral and had a poorer socioeconomic status. Their condition was more severe at the baseline, but their response to treatments did not differ from those with adolescent onset. Predatory and affective aggression and attention deficit hyperactivity disorder comorbidity were higher in children with prepubertal-onset CD. Regarding to sex, females were older and had a lower socioeconomic status. Their condition was more severe at the baseline and presented higher scores in self-aggression, but they responded better to treatments. Rates of attention deficit hyperactivity disorder were significantly lower in females, whereas other comorbidities (including substance abuse) were similar between sexes. Nonresponders to treatments received less frequently a psychosocial intervention, have more severe condition at the baseline, presented a more severe verbal and physical aggression, a lower affective/predatory index, and a higher rate of substance abuse. Conclusions: Age at onset and sex may be critical variables for prognosis of CD. Psychosocial intervention can significantly improve the treatment response. [Copyright &y& Elsevier]

Background: Increasing attention has been recently paid to precursors of bipolar disorder (BD). Symptoms of attention-deficit/hyperactivity disorder (ADHD) have been reported among the most common prodromes of BD. The aim of this study was to estimate the risk of BD in youths affected by ADHD based on prospective studies.Methods: A systematic review was conducted according to the PRISMA guidelines. A meta-analysis of single proportions was performed to compute the overall occurrence of BD in ADHD individuals. Binary outcome data were used to calculate risk estimates of BD occurrence in ADHD subjects versus Healthy Controls (HC).Results: An overall proportion of BD occurrence of 10.01% (95%-confidence interval [CI]: 6.47%-15.19%; I2 = 82.0%) was found among 1248 patients with ADHD over 10 prospective studies. A slightly higher proportion was found when excluding one study based on jack-knife sensitivity analysis (11.96%, 95%-CI: 9.15%-15.49%; I2 = 54.1%) and in three offspring studies (12.87%, 95%-CI: 8.91%-18.23%). BD occurrence was not significantly associated with mean follow-up duration (p-value = 0.2118). A greater risk of BD occurrence in ADHD versus HC from six studies was found (risk ratio: 8.97, 95%-CI: 4.26-18.87, p-value < 0.0001).Limitations: Few prospective studies have been retrieved in our search and most were not specifically aimed at assessing BD in followed-up ADHD patients.Conclusions: Greater clinical attention should be paid to ADHD as an early precursor of BD since a substantial proportion of ADHD patients is expected to be diagnosed with BD during the developmental age. [ABSTRACT FROM AUTHOR]

Background: Cyclothymic-hypersensitive temperament (CHT) has been related to both depression and bipolarity, as well as to suicidality. Recently, a psychometrically sound way of assessment has been validated in youth (Cyclothymic-Hypersensitive Temperament Questionnaire, CHTQ), but data on clinical populations are still scant. Aim of our study is to further explore the structure and other psychometric properties of the revised version of CHTQ and its clinical implications in clinical samples.Methods: The study is based on a dataset of patients with unipolar depression, bipolar disorder and attention deficit and hyperactivity disorder (ADHD) (243 patients, 135 males, mean age 14.22 ± 2.16 years, age range 9-18 years), compared to a community sample of adolescents (398 subjects, 95 boys, mean age 15.47 ± 1.96 years, age range 10-18 years) RESULTS: The two-correlated factor structure of CHT has been confirmed, with a moodiness/hypersensitiveness factor, correlated with internalizing symptoms, and an impulsiveness/emotional dysregulation factor, correlated with externalizing symptoms. All CHTQ scores correlate with global functioning. CHTQ total scores discriminate patients from healthy controls. Only CHTQ impulsiveness/emotional dysregulation subscale score is higher in bipolar patients, compared to unipolar depression and ADHD, whereas neither CHTQ moodiness/hypersensitiveness subscale score nor CHTQ total score discriminate between clinical groups.Limitation: Data on current mood states are unavailable. Patients were recruited in a third level clinic. The unipolar depression group is relatively small.Conclusion: CHT may be a rapid and reliable screening and diagnostic tool in the clinical practice with youth, exploring the cyclothymic dimension in different psychiatric disorders. [ABSTRACT FROM AUTHOR]

Callous-unemotional (CU) traits are associated with gaze pattern deficits in youths, though it has not yet been explored if environmental factors could influence this relationship. Since parenting can influence both CU traits and children's emotion processing, the current study sought to test whether parenting moderated the relation between gaze pattern deficits and CU traits in a sample of children with Disruptive Behavior Disorder. The sample included 92 boys (aged 7–12 years) with Conduct Disorder (N = 12) and Oppositional Defiant Disorder (N = 80). All children completed a task, during which they were presented with 24 images depicting happy, sad, fearful, disgusted, angry, and neutral facial expressions. Gaze pattern has been recorded throughout the task with an eye-tracker. Positive parenting moderated the association between CU traits and first fixation duration to the eyes of facial expressions depicting negative emotions. Negative parenting moderated the association between CU traits and fixation count and fixation duration to the eyes of negative emotions. Negative parenting along with reduced attention to emotional cues (i.e., eyes) may identify a group of youths with Disruptive Behavior Disorder diagnosis at risk for severe outcomes. • Parenting moderates the link between CU traits and gaze pattern impairments. • Negative parenting plus gaze pattern impairments may be risk factors for CU traits. • Targeting parenting and emotion processing skills could reduce youths' CU traits. [ABSTRACT FROM AUTHOR]

Universal prevention approaches have significantly reduced children's conduct problems and aggressive behavior in the school setting, but it has not been clear whether the effects generalize into children's behavior in home and community settings in later elementary school years. The present study examined this issue using a classroom-randomized design, with 1030 students in 70 fourth and fifth grade Italian classes. The intervention model is the Coping Power Universal and the classroom teachers delivered it. Coping Power Universal produced a significant reduction in both parents' and teachers' rated conduct problems, relative to control classes, indicating that universal prevention can produce significant reductions in children's conduct problems that generalize into the home and community settings. The intervention also increased children's prosocial behaviors in school and home settings. The Coping Power Universal is a short intervention model that is believed to be a useful strategy for children's behavioral problems in the broad population. [ABSTRACT FROM AUTHOR]

Abstract Research suggests that callous unemotional (CU) traits are associated with poor emotion recognition due to impairments in attention to relevant emotional cues. To further investigate the mechanisms that underlie CU traits, this study focused on the relationship between levels of CU and children's attention to, and recognition of, facial emotions. Participants were 7- to 10-year-old Italian boys, 35 with a diagnosis of Disruptive Behavior Disorder (age: M = 8.93, SD = 1.35), and 23 healthy male controls (age: M = 8.86, SD = 1.35). Children viewed standardized emotional faces (happiness, sadness, fear, disgust, anger, and neutral) while eye-tracking technology was used to evaluate scan paths for each area of interest (eyes, face, mouth), and for each emotion. CU traits were assessed using parent and teacher ratings on the Antisocial Process Screening Device. In the whole sample, elevated levels of CU traits were associated with a lower ability to recognize sadness, a lower number of fixations, and a lower average length of each fixation, specifically to the eye area of sad faces. In children with Disruptive Behavior Disorder diagnoses, high levels of CU traits were associated with lower duration of fixations to the eye-region on the eye area of sad faces, which in turns predicted lower levels of sadness recognition. The findings confirm that poor emotion recognition is associated with impairments in attention to critical information about other people's emotions. The clinical implications are discussed. Highlights • We recruited 35 children with Disruptive Behavior Disorder, and 23 healthy controls. • We used eye-tracking technology to evaluate eye gaze while the children processed emotional faces. • High levels of CU traits were associated with lower sadness recognition. • CU traits were related with a lower number and length of fixation on the eyes of sad faces. • The length of fixations to the eye-region mediated sadness recognition. [ABSTRACT FROM AUTHOR]