Skip to main content

Advertisement

Log in

Associations between trait anxiety and psychopathological characteristics of children at high risk for severe antisocial development

  • Original Article
  • Published:
ADHD Attention Deficit and Hyperactivity Disorders

Abstract

It is thought that among children at a high risk for antisocial personality disorder, the level of individual anxiety might constitute an important marker with respect to symptomatology and prognosis. The aim of the present study was to examine whether associations between anxiety and subtypes of aggression (proactive and reactive) exist in boys with early-onset subtype of conduct disorder (CD) and co-morbid attention-deficit hyperactivity disorder (ADHD). A detailed psychometric characterization of boys with ADHD and the early-onset subtype of CD (n = 33) compared to healthy controls (n = 33) was performed. The assessment included trait anxiety, internalizing and externalizing problems, symptoms of psychopathy and temperament traits, as well as subtypes of aggressive behavior. Descriptive statistics, correlation analyses, and group comparisons were calculated. The clinical group was characterized by higher levels of externalizing and internalizing symptoms. Individual anxiety was positively associated with harm avoidance, symptoms of oppositional defiant disorder (ODD), and by trend with reactive aggression. In contrast, boys with reduced levels of anxiety exhibited more callous-unemotional traits. Our results indicate that children with the early-onset subtype of CD and ADHD constitute a psychopathological heterogeneous group. The associations between individual levels of trait anxiety, temperament traits, and subtypes of aggressive behavior in children with ADHD and severe antisocial behavior emphasize the impact of anxiety as a potential key factor that might also be crucial for improvement in therapeutic strategies and outcome measures. Anxiety should be considered carefully in children with ADHD and the early-onset subtype of CD in order to optimize current therapeutic interventions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Achenbach TM (1991) Childbehavior checklist—deutsche version. Hogreve, Göttingen

    Google Scholar 

  • American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Press, Washington, DC

    Google Scholar 

  • Angold A, Costello EJ, Erkanli A (1999) Comorbidity. J Child Psychol Psychiatry 40(1):57–87

    Article  CAS  PubMed  Google Scholar 

  • Baker LA, Raine A, Liu J, Jacobson KC (2008) Differential genetic and environmental influences of reactive and proactive aggression in children. J Abnorm Child Psychol 36(8):1265–1278. doi:10.1007/s10802-008-9249-1

    Article  PubMed  Google Scholar 

  • Berkowitz L (1993) Aggression: its causes, consequences and control. Temple University Press, Philadelphia

    Google Scholar 

  • Breuer D, Wolff Metternich T, Dopfner M (2009) The assessment of attention deficit hyperactivity disorder (ADHD) by teacher ratings—validity and reliability of the fbb-hks. Z Kinder Jugendpsychiatr Psychother 37(5):431–440. doi:kij_37_5_431[pii]10.1024/1422-4917.37.5.431

    Article  PubMed  Google Scholar 

  • Bubier JL, Drabick DA (2009) Co-occurring anxiety and disruptive behavior disorders: the roles of anxious symptoms, reactive aggression, and shared risk processes. Clin Psychol Rev 29(7):658–669. doi:10.1016/j.cpr.2009.08.005-S0272-7358(09)00110-X

  • Coid J, Ullrich S (2010) Antisocial personality disorder and anxiety disorder: a diagnostic variant? J Anxiety Disord 24(5):452–460. doi:S0887-6185(10)00048-4[pii]10.1016/j.janxdis.2010.03.001

    Article  PubMed  Google Scholar 

  • Connor DF, Steingard RJ, Anderson JJ, Melloni RH Jr (2003) Gender differences in reactive and proactive aggression. Child Psychiatry Hum Dev 33(4):279–294

    Article  PubMed  Google Scholar 

  • Connor DF, Steingard RJ, Cunningham JA, Anderson JJ, Melloni RH Jr (2004) Proactive and reactive aggression in referred children and adolescents. Am J Orthopsychiatry 74(2):129–136. doi:10.1037/0002-9432.74.2.1292004-13484-005[pii]

    Article  PubMed  Google Scholar 

  • Connor DF, Chartier KG, Preen EC, Kaplan RF (2010) Impulsive aggression in attention-deficit/hyperactivity disorder: symptom severity, co-morbidity, and attention-deficit/hyperactivity disorder subtype. J Child Adolesc Psychopharmacol 20(2):119–126. doi:10.1089/cap.2009.0076

    Article  PubMed  Google Scholar 

  • De Brito SA, Hodgins S (2009) Antisocial personality disorder. In: McMurran M, Howard R (eds) Personality, personality disorder, and violence: an evidence based approach. Wiley, Chichester, pp 133–153

    Google Scholar 

  • Degnan KA, Fox NA (2007) Behavioral inhibition and anxiety disorders: multiple levels of a resilience process. Dev Psychopathol 19(3):729–746. doi:S0954579407000363[pii]10.1017/S0954579407000363

    Article  PubMed  Google Scholar 

  • Delmo C, Welffenbach O, Gabriel M, Stadler C, Poustka F (2001) Diagnostisches interview kiddie-sads present and lifetime version (k-sad-pl). Frankfurt

  • Dodge KA, Lochman JE, Harnish JD, Bates JE, Pettit GS (1997) Reactive and proactive aggression in school children and psychiatrically impaired chronically assaultive youth. J Abnorm Psychol 106(1):37–51

    Article  CAS  PubMed  Google Scholar 

  • Döpfner M, Lehmkuhl G (1998) Diagnostik-system für psychische störungen im kindes- und jugendalter nach icd-10 und dsm-iv. Huber, Bern

    Google Scholar 

  • Drabick DA, Gadow KD, Loney J (2008) Co-occurring odd and gad symptom groups: source-specific syndromes and cross-informant comorbidity. J Clin Child Adolesc Psychol 37(2):314–326. doi:793017614[pii]10.1080/15374410801955862

    Article  PubMed  Google Scholar 

  • Ford T, Goodman R, Meltzer H (2003) The british child and adolescent mental health survey 1999: the prevalence of dsm-iv disorders. J Am Acad Child Adolesc Psychiatry 42(10):1203–1211. doi:10.1097/00004583-200310000-00011S0890-8567(09)61983-3[pii]

    Article  PubMed  Google Scholar 

  • Fowles DC (2000) Electrodermal hyporeactivity and antisocial behavior: Does anxiety mediate the relationship? J Affect Disord 61(3):177–189

    Article  CAS  PubMed  Google Scholar 

  • Frick PJ (2009) Extending the construct of psychopathy to youth: Implications for understanding, diagnosing, and treating antisocial children and adolescents. Can J Psychiatry 54(12):803–812

    PubMed  Google Scholar 

  • Frick PJ, Hare R (2001) The antisocial process screening device (apsd). Multi-Health Systems, Berkshire

    Google Scholar 

  • Frick PJ, Marsee MA (2006) Psychopathy and developmental pathways to antisocial behavior in youth. In: Patrick C (ed) Handbook of psychopathy. Guilford Press, New York, pp 353–374

    Google Scholar 

  • Frick PJ, Cornell AH, Barry CT, Bodin SD, Dane HE (2003) Callous-unemotional traits and conduct problems in the prediction of conduct problem severity, aggression, and self-report of delinquency. J Abnorm Child Psychol 31(4):457–470

    Article  PubMed  Google Scholar 

  • Garland EJ, Garland OM (2001) Correlation between anxiety and oppositionality in a children’s mood and anxiety disorder clinic. Can J Psychiatry 46(10):953–958

    CAS  PubMed  Google Scholar 

  • Gregory AM, Caspi A, Moffitt TE, Koenen K, Eley TC, Poulton R (2007) Juvenile mental health histories of adults with anxiety disorders. Am J Psychiatry 164(2):301–308. doi:164/2/301[pii]10.1176/appi.ajp.164.2.301

    Article  PubMed  Google Scholar 

  • Herpertz SC, Wenning B, Mueller B, Qunaibi M, Sass H, Herpertz-Dahlmann B (2001) Psychophysiological responses in ADHD boys with and without conduct disorder: implications for adult antisocial behavior. J Am Acad Child Adolesc Psychiatry 40(10):1222–1230. doi:10.1097/00004583-200110000-00017

    Article  CAS  PubMed  Google Scholar 

  • Herpertz SC, Mueller B, Wenning B, Qunaibi M, Lichterfeld C, Herpertz-Dahlmann B (2003) Autonomic responses in boys with externalizing disorders. J Neural Transm 110(10):1181–1195. doi:10.1007/s00702-003-0026-6

    Article  CAS  PubMed  Google Scholar 

  • Herpertz SC, Mueller B, Qunaibi M, Lichterfeld C, Konrad K, Herpertz-Dahlmann B (2005) Response to emotional stimuli in boys with conduct disorder. Am J Psychiatry 162(6):1100–1107. doi:162/6/1100[pii]0.1176/appi.ajp.162.6.1100

    Article  PubMed  Google Scholar 

  • Herpertz-Dahlmann B, Konrad K, Herpertz S (2007) The role of ADHD in the etiology and outcome of antisocial behavior and psychopathy. In: Felthous A, Saß H (eds) International handbook on psychopathic disorders and the law, vol 1. Willey, England, pp 199–216

    Google Scholar 

  • Hodgins S, de Brito S, Simonoff E, Vloet T, Viding E (2009) Getting the phenotypes right: an essential ingredient for understanding aetiological mechanisms underlying persistent violence and developing effective treatments. Front Behav Neurosci 3:44. doi:10.3389/neuro.08.044.2009

    Article  PubMed  Google Scholar 

  • Hodgins S, De Brito S, Chhabra P, Cote G (in press) Anxiety disorders among offenders with antisocial personality disorders: a distinct subtype? Can J Psychiatry

  • Hubbard JA, Smithmyer CM, Ramsden SR, Parker EH, Flanagan KD, Dearing KF, Relyea N, Simons RF (2002) Observational, physiological, and self-report measures of children’s anger: relations to reactive versus proactive aggression. Child Dev 73(4):1101–1118

    Article  PubMed  Google Scholar 

  • Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P, Williamson D, Ryan N (1997) Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-pl): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 36(7):980–988. doi:S0890-8567(09)62555-7[pii]10.1097/00004583-199707000-00021

    Article  CAS  PubMed  Google Scholar 

  • Kazdin AE, Whitley MK (2006) Comorbidity, case complexity, and effects of evidence-based treatment for children referred for disruptive behavior. J Consult Clin Psychol 74(3):455–467. doi:2006-08433-006[pii]10.1037/0022-006X.74.3.455

    Article  PubMed  Google Scholar 

  • Kempes M, Matthys W, de Vries H, van Engeland H (2005) Reactive and proactive aggression in children–a review of theory, findings and the relevance for child and adolescent psychiatry. Eur Child Adolesc Psychiatry 14(1):11–19. doi:10.1007/s00787-005-0432-4

    Article  PubMed  Google Scholar 

  • Kerr M, Tremblay RE, Pagani L, Vitaro F (1997) Boys’ behavioral inhibition and the risk of later delinquency. Arch Gen Psychiatry 54(9):809–816

    CAS  PubMed  Google Scholar 

  • Lahey BB, Miller TL, Gordon RA, Riley AQ (1999) Developmental epidemiology of the disruptive behavior disorders. In: Quay HC, Hogan AE (eds) Handbook of disruptive behavior disorders in childhood and adolescence. Kluwer, New York, pp 449–477

    Google Scholar 

  • Lahey BB, Loeber R, Burke JD, Applegate B (2005) Predicting future antisocial personality disorder in males from a clinical assessment in childhood. J Consult Clin Psychol 73(3):389–399. doi:2005-06517-002[pii]10.1037/0022-006X.73.3.389

    Article  PubMed  Google Scholar 

  • Laux L, Glanzmann P, Schaffner P, Speilberger C (1981) Das state-trait-angstinventar (stai). Hogreve, Göttingen

    Google Scholar 

  • Lenzenweger MF, Lane MC, Loranger AW, Kessler RC (2007) Dsm-iv personality disorders in the national comorbidity survey replication. Biol Psychiatry 62(6):553–564. doi:S0006-3223(06)01192-9[pii]10.1016/j.biopsych.2006.09.019

    Article  PubMed  Google Scholar 

  • Loney BR, Lima EN, Butler MA (2006) Trait affectivity and non-referred adolescent conduct problems. J Clin Child Adolesc Psychol 35(2):329–336. doi:10.1207/s15374424jccp3502_17

    Article  PubMed  Google Scholar 

  • Lynam DR, Gudonis L (2005) The development of psychopathy. Annu Rev Clin Psychol 1:381–407. doi:10.1146/annurev.clinpsy.1.102803.144019

    Article  PubMed  Google Scholar 

  • Marmorstein NR (2007) Relationships between anxiety and externalizing disorders in youth: the influences of age and gender. J Anxiety Disord 21(3):420–432. doi:S0887-6185(06)00097-1[pii]10.1016/j.janxdis.2006.06.004

    Article  PubMed  Google Scholar 

  • Marsee MA, Weems CF (2008) Exploring the association between aggression and anxiety in youth: a look at aggressive subtypes, gender and social cognition. J Child Fam Stud 17:154–168

    Article  Google Scholar 

  • Masi G, Milone A, Manfredi A, Pari C, Paziente A, Millepiedi S (2008) Conduct disorder in referred children and adolescents: clinical and therapeutic issues. Compr Psychiatry 49(2):146–153. doi:S0010-440X(07)00120-4[pii]10.1016/j.comppsych.2007.08.009

    Article  PubMed  Google Scholar 

  • Moffitt TE, Caspi A, Harrington H, Milne BJ (2002) Males on the life-course-persistent and adolescence-limited antisocial pathways: follow-up at age 26 years. Dev Psychopathol 14(1):179–207

    Article  PubMed  Google Scholar 

  • Olsson M (2009) Dsm diagnosis of conduct disorder (cd)—a review. Nord J Psychiatry 63(2):102–112. doi:906737626[pii]10.1080/08039480802626939

    Article  PubMed  Google Scholar 

  • Petermann F, Petermann U (2007) Hamburg-wechsler-intelligenztest für kinder iv (hawik-iv). Hogrefe, Göttingen

    Google Scholar 

  • Pliszka S (2009) ADHD and comorbid disorders: psychosocial and psychopharmacological interventions. Guilford Press, New York

    Google Scholar 

  • Raine A, Dodge K, Loeber R, Gatzke-Kopp L, Lynam D, Reynolds C, Stouthamer-Loeber M, Liu J (2006) The reactive-proactive aggression questionnaire: differential correlates of reactive and proactive aggression in adolescent boys. Aggressive Behavior 32(2):159–171

    Article  PubMed  Google Scholar 

  • Rettew DC, Copeland W, Stanger C, Hudziak JJ (2004) Associations between temperament and dsm-iv externalizing disorders in children and adolescents. J Dev Behav Pediatr 25(6):383–391. doi:00004703-200412000-00001[pii]

    Article  PubMed  Google Scholar 

  • Sareen J, Stein MB, Cox BJ, Hassard ST (2004) Understanding comorbidity of anxiety disorders with antisocial behavior: findings from two large community surveys. J Nerv Ment Dis 192(3):178–186. doi:00005053-200403000-00002[pii]

    Article  PubMed  Google Scholar 

  • Scarpa A, Raine A (2004) The psychophysiology of child misconduct. Pediatr Ann 33(5):296–304

    PubMed  Google Scholar 

  • Schmeck K, Poustka F (2001) Temperament and disruptive behavior disorders. Psychopathology 34:159–163

    Article  CAS  PubMed  Google Scholar 

  • Schmeck K, Goth K, Poustka F, Cloninger RC (2001) Reliability and validity of the junior temperament and character inventory. Int J Methods Psychiatric Res 10(4):172–182. doi:10.1002/mpr.113

    Google Scholar 

  • Simonoff E, Elander J, Holmshaw J, Pickles A, Murray R, Rutter M (2004) Predictors of antisocial personality. Continuities from childhood to adult life. Br J Psychiatry 184:118–127

    Article  PubMed  Google Scholar 

  • Sourander A, Jensen P, Davies M, Niemelä S, Elonheimo H, Ristkari T, Helenius H, Sillanmäki L, Piha J, Kumpulainen K, Tamminen T, Moilanen I, Almqvist F (2007) Who is at greatest risk of adverse long-term outcomes? The finnish from boy to a man study. J Am Acad Child Adolesc Psychiatry 46:1148–1161

    Article  PubMed  Google Scholar 

  • Vitaro F, Brendgen M, Tremblay RE (2002) Reactively and proactively aggressive children: antecedent and subsequent characteristics. J Child Psychol Psychiatry 43(4):495–505

    Article  PubMed  Google Scholar 

  • Vloet TD, Herpertz S, Herpertz-Dahlmann B (2006) [aetiology and life-course of conduct disorder in childhood: Risk factors for the development of an antisocial personality disorder]. Z Kinder Jugendpsychiatr Psychother 34(2):101–114 (quiz 114–105)

    Google Scholar 

  • Vloet TD, Konrad K, Herpertz SC, Matthias K, Polier GG, Herpertz-Dahlmann B (2010) development of antisocial disorders—impact of the autonomic stress system. Fortschr Neurol Psychiatr 78(3):131–138. doi:10.1055/s-0028-1109981

    Article  CAS  PubMed  Google Scholar 

  • Walker JL, Lahey BB, Russo MF, Frick PJ, Christ MA, McBurnett K, Loeber R, Stouthamer-Loeber M, Green SM (1991) Anxiety, inhibition, and conduct disorder in children: I. Relations to social impairment. J Am Acad Child Adolesc Psychiatry 30(2):187–191. doi:10.1097/00004583-199103000-00004

    Google Scholar 

  • Washburn JJ, Romero EG, Welty LJ, Abram KM, Teplin LA, McClelland GM, Paskar LD (2007) Development of antisocial personality disorder in detained youths: the predictive value of mental disorders. J Consult Clin Psychol 75(2):221–231. doi:2007-04141-003[pii]10.1037/0022-006X.75.2.221

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Georg G. Polier.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Polier, G.G., Herpertz-Dahlmann, B., Matthias, K. et al. Associations between trait anxiety and psychopathological characteristics of children at high risk for severe antisocial development. ADHD Atten Def Hyp Disord 2, 185–193 (2010). https://doi.org/10.1007/s12402-010-0048-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12402-010-0048-5

Keywords

Navigation