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Background: Cannabis is the most commonly used illegal substance among adolescents and young adults. Problematic cannabis use is often associated with comorbid psychopathological problems. The purpose of the current study was to elucidate the underlying developmental processes connecting externalizing and internalizing psychopathology in childhood and adolescence with problematic cannabis use in young adulthood., Methods: Data were drawn from the Mannheim Study of Children at Risk, an ongoing epidemiological cohort study from birth to adulthood. For n=307 participants, symptom scores of conduct/oppositional defiant disorder, attention problems, hyperactivity/impulsivity, and internalizing disorders were available for the periods of childhood (4.5-11 years) and adolescence (15 years). At age 25 years, problematic cannabis use was assessed via clinical interview and a self-rating questionnaire., Results: At age 25 years, problematic cannabis use was identified in n=28 participants (9.1%). Childhood conduct/oppositional behavior problems were predictive of problematic cannabis use during young adulthood when comorbid symptoms were controlled for. No such effect was found for childhood attention, hyperactivity/impulsivity or internalizing problems. With respect to psychopathological symptoms during adolescence, only attention problems were significantly related to later problematic cannabis use when controlling for comorbidity., Conclusions: The current study highlights the role of conduct/oppositional behavior problems during childhood and attention problems during adolescence in later problematic cannabis use. It sheds more light on the developmental sequence of childhood and adolescence psychopathology and young adult cannabis use, which is a prerequisite for effective prevention approaches., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Recent longitudinal studies have indicated that affective and behavioral dysregulation in childhood is associated with an increased risk for various negative outcomes in later life. However, few studies to date have examined early mechanisms preceding dysregulation during early childhood. Aim of this study was to elucidate early mechanisms relating to dysregulation in later life using data from an epidemiological cohort study on the long-term outcome of early risk factors from birth to adulthood. At age 3 months, mothers and infants were videotaped during a nursing and playing situation. Maternal responsiveness was evaluated by trained raters. Infant regulatory problems were assessed on the basis of a parent interview and direct observation by trained raters. At age 8 and 11 years, 290 children (139 males) were rated on the Child Behavior Checklist (CBCL). Additionally, participants were genotyped for the dopamine D4 receptor (DRD4) exon 3 VNTR polymorphism. A significant three-way interaction between maternal responsiveness, DRD4 genotype and infant regulatory problems was detected predicting the CBCL-dysregulation profile (CBCL-DP). Carriers of the DRD4 7r allele with regulatory problems at age 3 months showed significantly more behavior problems associated with the CBCL-DP during childhood when exposed to less maternal responsiveness. In contrast, no effect of maternal responsiveness was observed in DRD4 7r carriers without infant regulatory problems and in non-carriers of the DRD4 7r allele. This prospective longitudinal study extends earlier findings regarding the association of the CBCL-DP with early parenting and later psychopathology, introducing both DRD4 genotype and infant regulatory problems as important moderators., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Epigenetic modulations are a hypothesized link between environmental factors and the development of psychiatric disorders. Research has suggested that patients with depression or bipolar disorder exhibit higher methylation levels in the glucocorticoid receptor gene NR3C1. We aimed to investigate whether NR3C1 methylation changes are similarly associated with externalizing disorders such as aggressive behavior and conduct disorder. NR3C1 exon 1F methylation was analyzed in young adults with a lifetime diagnosis of an externalizing disorder (N = 68) or a depressive disorder (N = 27) and healthy controls (N = 124) from the Mannheim Study of Children at Risk. The externalizing disorders group had significantly lower NR3C1 methylation levels than the lifetime depressive disorder group (p = 0.009) and healthy controls (p = 0.001) This report of lower methylation levels in NR3C1 in externalizing disorders may indicate a mechanism through which the differential development of externalizing disorders as opposed to depressive disorders might occur.

Objective: A difficult or undercontrolled temperament, as well as harsh parental discipline or a lack of warmth, has long been regarded as risk factors for the development of externalizing problems. In addition, it has been suggested that children with difficult temperament are especially susceptible to rearing influences. We investigated the impact of early temperament and parenting and their interactions on externalizing behavior at school age., Methods: Participants were 148 boys and 160 girls from a prospective longitudinal study on a high-risk sample. At ages 3 months and 2 years, temperament was assessed by a highly structured parent interview and standardized behavioral observations. Maternal parenting was assessed by videotaped behavioral observation and a parent questionnaire. Externalizing problems at age 8 years were measured by the Child Behavior Checklist., Results: Using hierarchical linear regression analyses, we found that externalizing problems were predicted by psychosocial adversity and poor self-control, whereas no main effect for restrictive parenting or maternal empathy was found. Fearful-inhibited boys were positively affected by empathic and sensitive parenting, whereas girls who were low in self-control and/or fearful developed less externalizing problems with restrictive parenting., Conclusion: Our results partly support the differential susceptibility hypothesis. In addition, they point toward gender-specific pathways in the development of externalizing problems., (Copyright © 2011 Elsevier Inc. All rights reserved.)

In this study, the association of aggressive behavior and personality traits with plasma cortisol levels was investigated in a high-risk community sample of adolescents. Plasma cortisol levels were collected in 245 fifteen-year-olds (118 males, 127 females) from an epidemiological cohort study of children at risk for psychopathology. Additionally, measures of reactive and proactive aggression, externalizing behavior and callous-unemotional together with impulsive personality features were assessed. Both subtypes of aggression as well as delinquent behavior and impulsive personality traits showed significant negative correlations with plasma cortisol levels. This association was observed in males, but not in females. In both gender groups, callous-unemotional traits were unrelated to plasma cortisol levels. This result suggests that the association between cortisol levels and aggression in adolescents is mediated rather by impulsivity than by unemotional or psychopathic traits.

In a high-risk community sample, we examined the role of regulative temperament and emotionality as well as the extent of gender specificity in the development of externalizing problems. 151 boys and 157 girls born at differing degrees of obstetric and psychosocial risk were followed from birth into adolescence. In infancy and childhood, NYLS-derived temperamental characteristics were assessed by a highly structured parent interview and standardized behavioral observations. At age 15 years, externalizing problems were measured by the Child Behavior Checklist. As revealed by multiple linear regression and logistic regression, low regulative abilities predicted adolescent behavioral and attentional problems over and above obstetric and psychosocial risks. Gender specificity was found in the strength of the association rather than in the kind with a stronger long-term prediction from infant and toddler temperament in girls. Compared to regulative abilities, temperament factors describing aspects of mood and fear/withdrawal versus approach tendencies played a minor role in the development of externalizing problems. Findings are discussed in terms of gender-specific risk factors and possible differential developmental trajectories to subtypes of disruptive behavior.

In the past decade, the living conditions of hearing impaired children have been changing due to new technologies and mainstreaming in schools. The majority of population-based studies in deaf pupils were conducted before these changes started to take place. The present study aimed to evaluate the current situation regarding aspects of mental health and, for the first time, quality of life in a representative sample of deaf pupils. The sample stems from a population of 145,000 pupils attending the first to ninth grades during the school years 2003-2005 in Upper Austria. From 186 children with bilateral hearing impairment of at least 40 dB registered at the centre for special education for children with sensory impairments, 99 with a performance IQ above 70 were included in the present study. Parents and teachers completed the strengths and difficulties questionnaire (SDQ), while parents and children were administered the inventory for the assessment of the quality of life in children and adolescents (ILC). Results indicated that deaf children scored significantly higher on the SDQ than their counterparts from normative samples according to both parent and teacher ratings. Differences were most marked with regard to conduct problems, emotional problems, and peer problems, and less marked for hyperactivity/inattention. While parents of deaf children had a generally positive view of their children's quality of life, deaf children provided a more complex picture, stressing areas of dissatisfaction. Mental health and quality of life were found to be unrelated to the child's degree of deafness.

Objective: Despite theoretical discrepancies between different concepts of temperament, some core dimensions are thought to be common to the various models. We compared temperamental traits derived from the New York Longitudinal Study (NYLS) model and the Cloninger dimensions in the developmental course and investigated the associations of temperament with sex as well as with obstetric risks or psychosocial risks present at birth., Methods: Participants were 151 boys and 157 girls born at differing degrees of obstetric and psychosocial risk from a longitudinal study on a high-risk community sample. In infancy and childhood, NYLS-derived temperamental characteristics were assessed by a highly structured parent interview and standardized behavioral observations. At age 15 years, the Junior Temperament and Character Inventory/12-18 was administered., Results: Moderate correlations were found between Junior Temperament and Character Inventory scales in adolescence and NYLS-derived factors in childhood. The psychosocial risk load seemed to influence the expression of novelty seeking or corresponding NYLS-derived factors, whereas the obstetric risks did not contribute to variation in temperament. Our findings further support highly sex-specific gene x environment interactions on temperament in the developmental course., Conclusion: The content of our NYLS-derived factors and the specific type of association across different temperament constructs fit into the increasing consensus regarding a small number of higher-order temperamental traits.

Objectives: The presence of certain alleles in polymorphisms of the dopamine receptor gene (DRD4) and the dopamine transporter gene (DAT1) increases a child's risk of developing ADHD or another mental disorder. We investigated whether or not the severity of the above-mentioned dopaminergic polymorphisms is associated with regulatory disorders in infancy., Methods: The Mannheim Study of Children at Risk interviewed parents of three-month-old children in depth about behavior problems and observed parents and children in various situations as well. The genotyping for DRD4 and DAT1 polymorphisms was carried out in the children by means of standard methods at the age of 15 years. Investigated were 300 children (145 boys, 155 girls) for whom complete datasets existed with regard to the research question., Results: Isolated regulatory problems were observed in 54 boys, respectively in 64 girls (37.2%, respectively 41.3%), while 17 boys, respectively 19 girls (11.7%, respectively 12.3%) exhibited multiple regulatory problems. In boys, the presence of the DRD4-7r allele was significantly associated with the occurrence of multiple regulatory problems (p = .04). No such association was found with regard to isolated regulatory problems, or among girls. There was no association for either gender between the DAT1 genotype (10r/10r vs. rest) and isolated or multiple regulatory problems., Conclusions: The result must be replicated in an independent sample before any conclusions can be drawn.

A variety of environmental and genetic factors modulating the risk for alcoholism have been described, which predominantly act by interacting with each other. For example, the family, peers and society determine the level of exposure to stress and alcohol, while genes modulate how sensitive an individual responds to both. The resulting behaviors feed back to the social environment, modulating and in the worst case increasing further stress exposure. We here review neurobiological evidence how such a process of mutual interaction can involve and affect drinking. In at-risk adolescents it may have been in force for many years before they have their first alcoholic drink, increasing their risk for addiction by generating allostatic load. As an example, psychiatric disorders involving attention deficit, hyperactivity, or disruptive behaviors first evolve during childhood and are influenced by all the above factors. They are also strongly associated with harmful adolescent drinking and later alcohol use disorders. One important implication of this concept is that issues such as family adversity, adolescent psychiatric disorders, or adolescent drinking might not only be associated with, but causally related to, the risk for later addiction. They are targets for preventive interventions, which should start as early as possible in subjects at-risk.

Aim: This study examined the extent to which fathers' and infants' interaction behavior were related to children's externalizing behavior problems at age 8 and 11 years., Methods: In a prospective longitudinal study of children at risk for later psychopathology, 72 fathers and their 3-month-old children were videotaped and evaluated during a standardized playing and nursing situation. Externalizing behavior problems at age 8 and 11 years were assessed using Achenbach's Child Behavior Checklist., Results: In the high externalizing group, fathers were found to be less responsive and less sensitive (the latter only with respect to girls) during early interaction than fathers of the low externalizing group, while children were more positive with their fathers. Furthermore, low scores on the interaction pattern of "sensitive fathering/negative infant" and high scores on the "nonresponsive fathering or active infant" pattern were associated with more externalizing problems., Conclusion: These findings suggest that father and infant interaction behaviors during early infancy may predict later problem behaviors at school age, although the mechanisms underlying this relationship have yet to be identified.

The objective of the present study was to examine gender differences in the influence of paternal alcoholism on children's social-emotional development and to determine whether paternal alcoholism is associated with a greater number of externalizing symptoms in the male offspring. From the Mannheim Study of Risk Children, an ongoing longitudinal study of a high-risk population, the developmental data of 219 children [193 (95 boys and 98 girls) of non-alcoholic fathers, non-COAs, and 26 (14 boys, 12 girls) of alcoholic fathers, COAs] were analyzed from birth to the age of 11 years. Paternal alcoholism was defined according to the ICD-10 categories of alcohol dependence and harmful use. Socio-demographic data, cognitive development, number and severity of behavior problems, and gender-related differences in the rates of externalizing and internalizing symptoms were assessed using standardized instruments (IQ tests, Child Behavior Checklist questionnaire and diagnostic interviews). The general linear model analysis revealed a significant overall effect of paternal alcoholism on the number of child psychiatric problems (F = 21.872, d.f. = 1.217, P < 0.001). Beginning at age 2, significantly higher numbers of externalizing symptoms were observed among COAs. In female COAs, a pattern similar to that of the male COAs emerged, with the predominance of delinquent and aggressive behavior. Unlike male COAs, females showed an increase of internalizing symptoms up to age 11 years. Of these, somatic complaints revealed the strongest discriminating effect in 11-year-old females. Children of alcoholic fathers are at high risk for psychopathology. Gender-related differences seem to exist and may contribute to different phenotypes during development from early childhood to adolescence.

The aim of this study is to examine the association between observed fathers' negativity in the interaction with their toddlers and internalizing problems of girls and boys at school age. In a prospective study of children at risk (Mannheim Study of Risk Children), 88 father-child dyads at the child's age of 2 years were videotaped and rated with a macro- and microanalytic coding system. Behavior problems were assessed at the age of 8 years using the Teacher Report Form of Achenbach's rating scales. Results revealed that fathers were more emotionally negative with their sons than with their daughters. No further differences in the fathers' interactive behavior according to child gender were found. However, fathers whose daughters had more internalizing problems (as seen by the teachers) at age 8 years were more restrictive and showed more inadequate control and negative interactive styles. In contrast, no predictive value of father negativity was observed in boys.

Aim: To examine whether regulatory problems in infancy predict later hyperkinetic symptoms in childhood and pre-adolescence., Methods: In a prospective longitudinal study of 319 children at risk of later developmental problems and psychopathology, hyperkinetic behaviour problems were assessed at the ages of 2, 4.5, 8 and 11 y by means of a standardized parent interview. Infant regulatory problems at the age of 3 mo were determined from multiple sources of information. An observational procedure was used to assess the quality of mother-infant interaction., Results: At the age of 3 mo, 17% of the infants (n = 55; 27 boys, 28 girls) suffered from multiple regulatory problems. Compared to a control group (n = 264), these children presented more hyperkinetic symptoms throughout childhood. Negativity in the mother-infant interaction and early family adversity each contributed to later hyperkinetic symptoms. When controlling for family adversity, the association between infant multiple regulatory problems and later hyperkinetic problems was rendered insignificant., Conclusions: These findings suggest that multiple regulatory problems may not be a key variable for later hyperkinetic problems. The impact of early family adversity factors clearly outweighed that of infant psychopathology on later behaviour disorder.

Mental disorders belong to the most frequent disorders in the community and lead to noticeable functional impairments. The lifetime prevalence of clinical depression (ICD-10 diagnoses F33, F34) up to age 25 is 12.7%, showing a female-male ratio of 2:1. From adolescence onwards, persistence rates of depressive disorders are comparably as high as those found in externalizing disorders. Subclinical depression (ICD-10 subthreshold disorders) at ages 8 and 13 increases the risk for later clinically relevant mental disorders. Conduct disorders (ICD-10 diagnoses F91, F92) are the most frequent mental disorders in children and adolescents with lifetime prevalence rates of 22.4% up to age 25. Conduct disorders show unfavorable courses beginning at preschool age. Precursors of later disorders can be detected as early as toddlerhood. Adverse family factors in childhood and early externalizing problems of the child were most predictive for later conduct disorders. Therefore, the need for early prevention of conduct disorders is highlighted. The focus should be on families with low socioeconomic status (objective: strengthening family and child resources). For depressive disorders, we recommend testing and evaluating the indicated prevention programs in adolescence (objective: strengthening the resources of the adolescent).

Aim: To determine the significance of young maternal age, family adversity and maternal behaviour during mother-toddler interaction in the prediction of child disruptive behaviour at age eight., Methods: From an ongoing longitudinal study of infants at risk for later psychopathology (n = 362), 72 young mothers aged between 15 and 24 y (median 22 y) at first birth were compared with 197 primiparous older mothers ranging in age from 25 to 41 y (median 29 y). Family adversity at childbirth was assessed using a modified version of Rutter's Family Adversity Index (FAI) and measures of child disruptive behaviour at age eight were obtained using Achenbach's Teacher Report Form (TRF). An observational procedure was used to assess maternal behaviour during mother-child interaction at the age of 2 y., Results: Young mothers encountered more adverse family characteristics and were more inadequate, restrictive and more negative during interaction with their toddlers. Their school-aged children showed higher scores on all disruptive behaviour scales of the TRF. Hierarchical regression analyses revealed that family adversity and maternal behaviour during toddler interaction could account for most of the association between early motherhood and child disruptive behaviour., Conclusion: The impact of young motherhood on child mental health is not confined to teenage mothers and is mainly attributed to psychosocial and interactional factors.

An atypical EEG pattern of frontal brain activation, which has been related to compromised emotional regulation in children and adults, is hypothesized to be also present in children with externalizing behavior problems. Seventy-eight children at 11 years of age were examined to answer the following questions: 1) do children with externalizing behaviors exhibit an atypical pattern of frontal brain activation which can be linked to the severity of their problem behaviors? and 2) are there gender differences in these frontal activation patterns? Spontaneous EEG activity was subjected to power spectral analysis. In externalizing girls, the well-known pattern of a significantly greater right than left frontal brain activation emerged that has been found previously in emotionally disordered children, whereas healthy girls showed a significantly greater left than right frontal activation. In contrast, healthy boys demonstrated a significantly greater right than left frontal activation, whereas externalizing boys did not display a frontal brain asymmetry. Thus, the pattern of frontal brain activation was gender specific. The atypical activation pattern in externalizing children is hypothesized to be a biological correlate of difficulties in regulating emotion.

Objectives: In spite of a growing interest in recent years in epidemiological research on behavior problems of children of alcoholics (COAs), few prospective longitudinal child psychiatric studies have been conducted up to now., Methods: In the Mannheim Study of Risk Children, an ongoing prospective study of high risks, the data of 219 children (26 COAs and 193 non-COAs) were analyzed from birth to the age of 11 years. Sociodemographic data, organic and psychosocial risk factors, the number and severity of behavior problems, and the rate of expansive and introversive disorders have been investigated., Results: The family status of the COAs was characterized by the father's lower level of education as well as by socioeconomic difficulties and more numerous adverse life events. Other psychosocial problems such as marital conflict and a lack of coping mechanisms were also more frequent in COA families. A significantly higher rate of expansive symptoms and disorders was found in children of alcoholic fathers from the age of two years on., Conclusions: Children of alcoholic fathers represent a group at risk for the early onset of psychiatric problems and are deserving of more attention in prevention and early intervention programs.

The development of behaviour problems in infants born with biological risk (low birthweight) and psychosocial risk (psychosocially disadvantaged family) was studied in a sample of 347 children (171 males, 176 females) at the ages of 2, 4:6, and 8 years. In the search for factors that moderate the effects of early risks, the role of early responsive caregiving was examined. Results indicate that infants at psychosocial risk exhibited both more externalizing and internalizing problems across ages than infants not at psychosocial risk, while no overall differences were apparent between normal- and low-birthweight groups. With one exception, no interactions between biological and psychosocial risk factors emerged, suggesting that their simultaneous effect is largely additive. Maternal responsivity was found to moderate the effects of low birthweight on hyperkinetic and internalizing problems as well as to influence the consequences of family disadvantage on total problems. These findings stress the importance of early parenting in the behavioural development of at-risk children.

Objective: This prospective longitudinal study investigated the simultaneous impact of early biological and psychosocial risk factors on behavioral outcome at school age., Method: A cohort of 362 children born between 1986 and 1988 with different biological (perinatal insults) and psychosocial risk factors (family adversity) was followed from birth to school age. When their children were aged 8 years, parents of 89.0% of the initial sample completed the Child Behavior Checklist (CBCL)., Results: More externalizing as well as internalizing problems were found in children born into adverse family backgrounds, whereas no differences at broad-band syndrome level were apparent between groups with varying obstetric complications. Children with family risk factors had higher scores on 5 of the 8 CBCL scales (including attention, delinquent, and aggressive problems), whereas children with perinatal risk factors had more social and attention problems than children in the nonrisk groups. With one exception, no interactions between risk factors emerged, indicating that perinatal and family risk factors contributed independently to outcome. The differences between risk groups applied irrespective of gender., Conclusions: The adverse impact of family adversity clearly outweighed the influence of obstetric complications in determining behavioral adjustment at school age.

In a prospective longitudinal study on child development from birth to age eight 362 first-born infants and their families were investigated. The subjects were distributed across the nine cells of a two-factorial design, factor 1 representing the degree of organic, factor 2 the degree of psychosocial risk. At age 3 months mother-child interaction was videotaped and evaluated with microanalytic technique. The quality of MCI could be demonstrated to be as predictive for later cognitive development as early developmental tests. Social-emotional problems of the toddler and preschool child was predicted better by parameters of early MCI than by temperament. Disturbed interactions were associated with later cognitive retardation and enhanced behavior problems. MCI is significantly determined by neglect and rejection, which showed typical behavioral patterns. The early separation of mother and high risk newborn itself did not lead to alterations in maternal attachment. Compared with mother daughter dyads early interaction of mother and son was characterized by more reactivity and positive emotion.

In a prospective longitudinal study the influence of biological and psychosocial risk on early emotional and behaviour problems was investigated in a high-risk sample. Adverse characteristics of temperament and psychosomatic symptoms were assessed in 362 infants aged 3 months by observation of behaviour and parent interview instruments. Results showed cumulative negative effects of nearly equal significance of both biological and psychosocial risk on the severity and number of behavioural disturbances. No sex differences and no interaction of risk factors were found. Detailed analysis revealed that single risk factors were related to different patterns of infant behaviour problems.

In a prospective longitudinal epidemiological study with assessments at age 8, 13 and 18 the prevalence rate for psychiatric disorders remained constant at about 16%. The sex ratio for severe disorders was male dominated even in adolescence, which was a consequence of the high rate of unsocialized disturbances of conduct in boys. Persistence of psychiatric disorders between age 13 and 18 was about 50%, as had previously been the case between age 8 and 13. One child in four suffered from a psychiatric disorder for at least 10 years. In childhood, conduct disorders had a very poor prognosis and emotional disorders a very good one. In adolescence, the course of disorders depended on an interaction between diagnosis and gender. Boys with unsocialized disturbances and girls with emotional problems had a poor prognosis.

In a study on the psychological development of children born at biological and psychosocial risk adverse temperamental characteristics and psychopathological symptoms of 362 children were determined at the ages of 3 and 24 months. Adverse temperamental characteristics were measured with the help of behavioral observations in standardized situations. Symptoms were assessed in a highly structured parent interview. The results showed a higher-than-average rate of disturbed children, which increased from 15.5% at the age of 3 months to 19.5% at two years. Hyperkinesis was the most prevalent disturbance. Whereas no sex effect was found among infants, the 2-year-old boys manifested more symptoms and had more adverse temperamental characteristics than the 2-year-old girl. Sex differences in symptom patterns were similar to those seen in later childhood. The course of early disturbances was characterized by low persistence and stability. Four fifths of all infant disturbances had remitted by the age of two years. A small number of early problems (i.e. eating disorders) turned out to be predictive of later disorders.

As part of an epidemiological follow-up study, data collected from 356 children at ages 8 and 13 and from their parents were analyzed to examine the relationship of parental child-rearing behavior and parents' psychological problems to the intellectual, emotional and social development of the offspring. The results revealed that while children are growing up father and child influence each other in specific ways. The fathers were particularly active in developing their children's cognitive abilities and had a strong influence especially on the development of their sons. At both age 8 and age 13, children whose parents had psychiatric disturbances, regardless of which parent was affected, were much more likely than those with normal parents to have psychiatric disorders themselves. Significant parental gender effects were found, however, when the form of the child's disorder was considered: At age 13, the children were at a higher risk for a conduct disorder if the father had a problem than if the mother did. In further analyses, children who had lost their fathers were compared with those in intact families. Significantly higher rates of psychiatric disorders were found for the fatherless boys, whereas no such effect could be detected for the fatherless girls.