To curb violent tendencies, start young Working with aggressive children prevents some from becoming violent, criminal adults

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DURHAM, N.C. -- Aggressive children are less likely to become violent criminals or psychiatrically troubled adults if they receive early intervention, says a new study based on more than two decades of research. "These findings from researchers at Duke, Pennsylvania State and Vanderbilt universities and the University of Washington are based on the Fast Track Project, a multi-faceted program that is one of the largest violence-prevention trials ever funded by the federal government. Beginning in 1991, the researchers screened nearly 10,000 5-year-old children in Durham, Nashville, Seattle and rural Pennsylvania for aggressive behavior problems, identifying those who were at highest risk of growing up to become violent, antisocial adults. Nearly 900 children were deemed at high risk, and of those, half were randomly assigned to receive the Fast Track intervention, while the other half were assigned to a control group. Participating children and their families received an array of interventions at school and at home. Nineteen years later, the authors found that Fast Track participants at age 25 had fewer convictions for violent and drug-related crimes, lower rates of serious substance abuse, lower rates of risky sexual behavior and fewer psychiatric problems than the control group. "We can prevent serious violence and psychopathology among the group of children who are highest-risk," said Duke's Kenneth Dodge. "That's the essential finding from this study. It provides the strongest evidence yet that, far from being doomed from an early age, at-risk children can be helped to live productive lives." Dodge directs the Duke Center for Child and Family Policy and is the William McDougall Professor of Public Policy at Duke's Sanford School of Public Policy. The program's positive effects held true across four different sites around the country, among both males and females and among both white and African-American children. The study appears online Sept. 15 in the American Journal of Psychiatry. From first through 10th grade, the Fast Track children received reading tutoring and specialized intervention aimed at improving self-control and social-cognitive skills. Parents learned problem-solving skills through home visits and parent training groups. When program participants turned 25, researchers reviewed court records and conducted interviews with participants and control group members, as well as individuals who knew the participants well. Along with fewer criminal convictions, Fast Track participants had lower rates of antisocial personality disorder and avoidant personality disorder, lower rates of risky sexual behavior and lower rates of harsh parenting. The latter finding suggests that the intervention may interrupt the inter-generational cycle of problem behavior. Fast Track is among very few studies to test the long-term effect of environment on children's development through a clinical trial. It provides strong evidence for the critical role environment plays in shaping a child's development. "This study adds to the experimental evidence for the important role that environment plays," Dodge said. "Genes do not write an inalterable script for a child's life. And not only does the environment matter greatly in a child's development, we've shown that you can intervene and help that child succeed in life." Fast Track's positive effects do not come cheap. The 10-year intervention costs $58,000 per child. However, that cost should be weighed against the millions of dollars that each chronic criminal costs society in imprisonment and harm to others, Dodge said. "Prevention takes a considerable investment, but that investment is worth it," Dodge said. "Our policies and practices should reflect the fact that these children can have productive lives." In future studies, Dodge and his colleagues plan to examine the cost-benefit question more closely. ### The research was supported by grants from the National Institute of Mental Health (NIMH R18 MH48043, R18 MH50951, R18 MH50952, R18 MH50953, K05MH00797 and K05MH01027), the Department of Education (grant S184U30002) and the National Institute on Drug Abuse (NIDA grants DA16903, DA017589, K05DA015226, and P30DA023026). The Center for Substance Abuse Prevention and the National Institute on Drug Abuse also provided support through a memorandum of agreement with the NIMH. Financial disclosure: Study authors Kenneth Dodge, Karen Bierman, John Coie, Mark Greenberg, John Lochman and Robert McMahon are the developers of the Fast Track curriculum and have a publishing agreement with Guilford Press. Greenberg is also an author of the PATHS curriculum, which is used in the Fast Track program. McMahon is a co-author of Helping the Noncompliant Child and has a royalty agreement with Guilford Publications. He is also a member of the Treatments that Work Scientific Advisory Board with Oxford University Press. The other authors have no financial relationships to disclose." CITATION: "Impact of Early Intervention on Psychopathology, Crime and Well-Being at Age 25," Kenneth A. Dodge and the Conduct Problems Prevention Research Group. American Journal of Psychiatry, September 15, 2014. DOI: 10.1176/appi.ajp.2014.13060786. For more information on mental health topis, please visit CEUs for Counselors

Neurobiologists find chronic stress in early life causes anxiety, aggression in adulthood

Cold Spring Harbor, NY -- In recent years, behavioral neuroscientists have debated the meaning and significance of a plethora of independently conducted experiments seeking to establish the impact of chronic, early-life stress upon behavior – both at the time that stress is experienced, and upon the same individuals later in life, during adulthood. These experiments, typically conducted in rodents, have on the one hand clearly indicated a link between certain kinds of early stress and dysfunction in the neuroendocrine system, particularly in the so-called HPA axis (hypothalamic-pituitary-adrenal), which regulates the endocrine glands and stress hormones including corticotropin and glucocorticoid. Yet the evidence is by no means unequivocal. Stress studies in rodents have also clearly identified a native capacity, stronger in some individuals than others, and seemingly weak or absent in still others, to bounce back from chronic early-life stress. Some rodents subjected to early life stress have no apparent behavioral consequences in adulthood – they are disposed neither to anxiety nor depression, the classic pathologies understood to be induced by stress in certain individuals. Today, a research team led by Associate Professor Grigori Enikolopov of Cold Spring Harbor Laboratory (CSHL) reports online in the journal PlOS One the results of experiments designed to assess the impacts of social stress upon adolescent mice, both at the time they are experienced and during adulthood. Involving many different kinds of stress tests and means of measuring their impacts, the research indicates that a "hostile environment in adolescence disturbs psychoemotional state and social behaviors of animals in adult life," the team says. The tests began with 1-month-old male mice – the equivalent, in human terms of adolescents -- each placed for 2 weeks in a cage shared with an aggressive adult male. The animals were separated by a transparent perforated partition, but the young males were exposed daily to short attacks by the adult males. This kind of chronic activity produces what neurobiologists call social-defeat stress in the young mice. These mice were then studied in a range of behavioral tests. "The tests assessed levels of anxiety, depression, and capacity to socialize and communicate with an unfamiliar partner," explains Enikolopov. These experiments showed that in young mice chronic social defeat induced high levels of anxiety helplessness, diminished social interaction, and diminished ability to communicate with other young animals. Stressed mice also had less new nerve-cell growth (neurogenesis) in a portion of the hippocampus known to be affected in depression: the subgranular zone of the dentate gyrus. Another group of young mice was also exposed to social stress, but was then placed for several weeks in an unstressful environment. Following this "rest" period, these mice, now old enough to be considered adults, were tested in the same manner as the other cohort. In this second, now-adult group, most of the behaviors impacted by social defeat returned to normal, as did neurogenesis, which retuned to a level seen in healthy controls. "This shows that young mice, exposed to adult aggressors, were largely resilient biologically and behaviorally," says Dr. Enikolopov. However, in these resilient mice, the team measured two latent impacts on behavior. As adults they were abnormally anxious, and were observed to be more aggressive in their social interactions. "The exposure to a hostile environment during their adolescence had profound consequences in terms of emotional state and the ability to interact with peers," Dr. Enikolopov observes. ### The research described in this release was supported by the Russian Foundation for Basic Research and by the National Institute of Mental Health. "Extended Effect of Chronic Social Defeat Stress in Childhood on Behaviors in Adulthood" appears online in PlOS One Tuesday, March 25, 2014. The authors are: Irina L. Kovalenko, Anna G. Galyamina, Dmitry A. Smagin, Tatyana V. Michurina, Natalia N. Kudryavtseva and Grigori Enikolopov. About Cold Spring Harbor Laboratory Founded in 1890, Cold Spring Harbor Laboratory (CSHL) has shaped contemporary biomedical research and education with programs in cancer, neuroscience, plant biology and quantitative biology. CSHL is ranked number one in the world by Thomson Reuters for the impact of its research in molecular biology and genetics. The Laboratory has been home to eight Nobel Prize winners. Today, CSHL's multidisciplinary scientific community is more than 600 researchers and technicians strong and its Meetings & Courses program hosts more than 12,000 scientists from around the world each year to its Long Island campus and its China center LCSW Continuing Education

Bad boys: Research predicts whether boys will grow out of it -- or not

ANN ARBOR --- Using the hi-tech tools of a new field called neurogenetics and a few simple questions for parents, a University of Michigan researcher is beginning to understand which boys are simply being boys and which may be headed for trouble. “When young children lie or cheat or steal, parents naturally wonder if they’ll grow out of it,” says Luke Hyde, a U-M psychologist who is studying the development and treatment of antisocial behavior. Hyde, a faculty associate at the U-M Institute for Social Research (ISR) and assistant professor of psychology, is speaking at ISR on November 11 on how genes, experience and the brain work together to heighten or reduce the risks that normal childhood transgressions will develop into full-blown conduct disorders in adolescence and early adulthood. His talk is part of the ISR Research Center for Group Dynamics seminar series on violence and aggression, and is free and open to the public. “The lifetime prevalence of conduct disorder is around 10 percent, and even higher in males and low-income populations,” says Hyde. “The total cost to society is enormous, since these behaviors are often chronic, lasting through adulthood.” MHC Continuing Education With colleagues at U-M, Duke University, the University of Pittsburgh, and other institutions, Hyde has been exploring the role of the environment and biology as they interact over time to shape behavior. In particular, he is using the techniques of a new field called neurogenetics, which combines genetics, neuroscience and psychology, to learn how genes and neural processes interact with harsh environments, including dangerous neighborhoods and harsh parents, and with a child’s own levels of empathy and personality traits, to increase the risk of antisocial behavior. In one recent study, for example, Hyde and colleagues studied subjects with over-reactive amygdala responses . The amygdala is an almond-shaped part of the brain’s primitive limbic system involved in processing fear and other visceral emotions. It has been associated with impulsive, aggressive behavior, as well as anxiety disorders and depression. “Previous research suggests that the amygdala becomes over-reactive probably as a result of both genetics and experience,” says Hyde. “And once the amygdala is over-reactive, people tend to behave in an anxious, over-reactive way to things they see as a potential threat. “Our study found that this tendency is moderated by a person’s environment, including the social support they get. If they’re not getting support from family, friends, neighbors, or professionals, then the link between the amygdala and anxious behavior is much stronger.” In another study, Hyde and colleagues showed that kids who are impulsive are only at higher risk of engaging in antisocial behavior if they live in dangerous neighborhoods. He also identified specific items within childhood behavior checklists that can be used as early as the age of three to identify kids who will likely have worse trajectories for anti-social behavior compared to other children who have similar behavior problems, such as throwing tantrums. These items assess observable behaviors that include whether the child is cruel to animals, doesn’t seem to feel guilty after misbehaving, is sneaky, lies, is selfish or won’t share, and won’t change his or her behavior as a result of punishment. “The results of this test aren’t really meaningful until age three or three-and-a-half,” says Hyde. “Before that, many of these behaviors are fairly common, and don’t predict anything. But after age three, if children are still behaving in these ways, their behavior is more likely to escalate in the following years rather than improve.” There is good news, though. Kids who scored high on this test benefitted just as much as other kids from interventions, according to Hyde. These interventions, often called parent management training, focus on giving parents better skills to manage child behavior problems, including training parents to spend more positive time with their kids, use time-outs instead of physical punishments, and reward good behavior by giving out stickers. “Parents need to know that intervention works, especially if it’s done early,” says Hyde. “They need to go for help if they see signs of trouble. Clinical psychologists, among other professionals, have empirically supported treatments that are quite effective for children, especially in this age period.” ### Funding for this research was provided by The National Institute of Drug Abuse, the National Institute of Mental Health, and the National Heart, Lung and Blood Institute. Established in 1949, the University of Michigan Institute for Social Research (ISR) is the world's largest academic social science survey and research organization, and a world leader in developing and applying social science methodology, and educating researchers and students from around the world. For more information, visit the ISR Web site at http://home.isr.umich.edu

Simple tool may help inexperienced psychiatrists better predict violence risk in patients, U-M study finds

Without assessment tool, inexperienced psychiatrists less likely to accurately predict violence ANN ARBOR, Mich. Inexperienced psychiatrists are less likely than their veteran peers to accurately predict violence by their patients, but a simple assessment checklist might help bridge that accuracy gap, according to new research from the University of Michigan. Led by psychiatrist Alan Teo, M.D., a Robert Wood Johnson Foundation Clinical Scholar of the University of Michigan, researchers examined how accurate psychiatrists were at predicting assaults by acutely ill patients admitted to psychiatric units. Their results found that inexperienced psychiatric resident doctors did no better than a coin flip, whereas veteran psychiatrists were 70 percent accurate in predicting risk of violence. However, when a brief risk assessment tool was applied to the cases that the junior doctors evaluated, their level of accuracy jumped to 67 percent, or nearly as good as the more experienced psychiatrists. Results of the research were published online Sept. 1 in the journal Psychiatric Services. “The tool we used, called the HCR-20-C, is remarkably brief and straightforward. Like a checklist a pilot might use before takeoff, it has just five items that any trained mental health professional can assess,” Teo says. In light of recent violent events, such as the movie theater shooting in Aurora, Colo,, earlier this summer, Teo says predicting violence risk in psychiatric patients is an increasingly important topic. “Given public concern about this issue, I think teaching our budding psychiatrists and others how to use a practical tool like this, and encouraging its use in high-risk settings is a no-brainer,” he says. In the study, researchers were able to assess doctors’ accuracy by comparing patients who had assaulted hospital staff members with similar patients who had not been violent. Because all patients received a threat assessment when admitted to the psychiatric unit, the researchers were able to compare a patient’s predicted violence risk with whether they actually had a documented assault while in the hospital. Incidents of physical aggression typically included punching, slapping, or throwing objects, as well as yelling, directed at staff members of the hospital. The patients studied had severe illnesses, often schizophrenia, and had been involuntarily admitted to the hospital. Teo says this study is the first to compare the predictive success of violence assessment between experienced and inexperienced psychiatrists. The results, he says, highlight the importance of emphasizing violence risk assessment in clinical training programs ceus for counselors “If trainees are indeed less able than trained and experienced clinicians to accurately perform risk assessments for violence, it’s important to figure out a way to improve their accuracy,” he says. “Our study shows that evidence-based structured tools might have the potential to augment training and improve risk assessment.” ### Citation: Psychiatric Services, Sept. 1, 2012; doi: 10.1176/appi.ps.201200019 Other authors: Sarah R. Holley, Ph.D.; Mary Leary, M.D.; Dale E. McNiel, Ph.D. Conflicts of interest: None. Funding: This work was partly supported by the National Institute of Mental Health (grant R25 MH060482), a Minority Fellowship sponsored by the American Psychiatric Association and the Substance Abuse and Mental Health Services Administration, and a Clinical and Translational Science Award (ULI RR024131) from the National Institutes of Health.