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| 2. |
- Carlstedt, Anita, et al.
(författare)
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Does Victim Age Differentiate Between Perpetrators of Sexual Child Abuse? A Study of Mental Health, Psychosocial Circumstances, and Crimes
- 2009
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Ingår i: Sexual Abuse. - : SAGE Publications. - 1079-0632 .- 1573-286X. ; 21:4, s. 442-454
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Tidskriftsartikel (refereegranskat)abstract
- To test the theory that sexual offenders who abuse very young children (0-5 years) have more severe mental health and psychosocial problems than those who victimize older children, authors compared psychiatric diagnoses, social circumstances, and crime-related data in all sexual offenders against minors referred to forensic psychiatric investigation in Sweden during a 5-year period. Thirty-one men had committed index crimes involving victims between the ages of 0 and 5 years (Group 1), 90 had 6- to 11-year-old victims (Group 2), and 41 had 12- to 15-year-old victims (Group 3). All three offender groups were characterized by severe mental health problems, in many cases fulfilling American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for both Axis I and Axis II diagnoses, but these problems did not differ between groups. Neither did social situation or sexual orientation. Offenders with 0- to 5-year-old victims significantly more often abused both boys and girls. Frequencies of retrospectively diagnosed childhood-onset behavior disorders were high in all three offender groups. The authors' data did not support previous findings of increasingly severe mental health problems with decreasing victim age.
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| 3. |
- Hofvander, Björn
(författare)
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AD/HD and autism spectrum disorders in adults
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Attention deficit/hyperactivity disorder (AD/HD) and autism spectrum disorders (ASDs) are early-onset, but often life-time impairing, neurodevelopmental disorders. They are highly overlapping and seem to carry considerable risks of negative outcomes, psychiatrically and psychosocially. Childhood hyperactivity is a known risk factor for early-onset conduct disorder (CD), but details concerning the associations between neurodevelopmental problems, aggression, and antisocial personality disorder (ASPD) in adult age are still uncertain. The current diagnostic subdivision of the ASDs is based on children, while the adult characteristics, including patterns of comorbidity and psychosocial adversities, have been less studied, especially in subjects without concomitant intellectual disability. Objectives: The overall aim of this thesis was to describe the adult outcome of AD/HD and ASDs. Specific aims were to: (1) review prospective, longitudinal studies of the adult outcome of childhood hyperactivity, equivalent to AD/HD, with special regard to ASPD, (2) investigate the relationships between AD/HD, ASDs, and different types of aggressive behaviours, (3) describe the clinical presentation, including personality development and psychosocial outcome, in normal-intelligence adult subjects with ASDs. Method: The first paper is a systematic meta-analysis of published studies. The subsequent studies are descriptive analyses of common clinical assessment protocols from consecutive groups of adults either referred for clinical evaluations of childhood-onset neuropsychiatric disorders, for forensic psychiatric investigations, or recruited to a population-based, longitudinal study of teenage-onset anorexia nervosa (AN). Results: Childhood hyperactivity increases the risk for CD, which is found in at least one-third of all hyperactive children, forming the starting point for the development of aggressive antisociality in adulthood in about half of cases with the combination of hyperactivity and CD in childhood. Support for the hypothesis that childhood hyperactivity, in the absence of early CD, carries a risk for adult ASPD, is still lacking (Paper I). Both conditions are, however, predictors of aggression in adults, together with substance-related disorders and poor development of the character trait Cooperativeness. ASD traits or symptoms did not generally predict aggression but may be associated with unique violent offences (Paper II). Among subjects with normal-intelligence ASDs, life-time psychiatric comorbidity was very high, and measures of outcome indicated low psychosocial functioning. AD/HD was common in all ASD subject categories studied with the notable exception of subjects with AN, none of whom had AD/HD. ASPD and substance-related disorders were more common in patients with an atypical ASD as compared to Asperger´s disorder or autistic disorder. Among all adults diagnosed with an ASD, less than half led an independent life and comparatively few had ever had a long-term relationship. Female subjects more often reported having been bullied at school than male subjects (Paper III and IV). Discussion and conclusions: Childhood-onset neuropsychiatric conditions such as AD/HD and ASDs are relevant for adult psychiatric phenotypes but insufficiently studied. Current classifications suffer from the hiatus between child- and adolescent psychiatry and adult psychiatry and future diagnostic concepts ought to be longitudinal with a life-time perspective on cognitive and emotional development and a patient-centred focus rather than fragmented into complex patterns of “comorbidities”.
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| 4. |
- Hofvander, Björn, et al.
(författare)
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Continuity of aggressive antisocial behavior from childhood to adulthood: The question of phenotype definition.
- 2009
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Ingår i: International Journal of Law and Psychiatry. - : Elsevier BV. - 0160-2527. ; 32:4, s. 224-234
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Tidskriftsartikel (refereegranskat)abstract
- Aiming to clarify the adult phenotype of antisocial personality disorder (ASPD), the empirical literature on its childhood background among the disruptive behaviour disorders, such as attention deficit/hyperactivity disorder (AD/HD), oppositional defiant disorder (ODD), conduct disorder (CD), or hyperkinetic conduct disorder (HKCD), was reviewed according to the Robins and Guze criteria for nosological validity. At least half of hyperactive children develop ODD and about a third CD (i.e. AD/HD+CD or HKCD) before puberty. About half of children with this combined problem constellation develop antisocial personality disorder (ASPD) in adulthood. Family and adoption/twin studies indicate that AD/HD and CD share a high heritability and that, in addition, there may be specific environmental effects for criminal behaviours. "Zones of rarity" delineating the disorders from each other, or from the normal variation, have not been identified. Neurophysiology, brain imaging, neurochemistry, neurocognition, or molecular genetics have not provided "external validity" for any of the diagnostic categories used today. Deficient mental functions, such as inattention, poor executive functions, poor verbal learning, and impaired social interaction (empathy), seem to form unspecific susceptibility factors. As none of today's proposed syndromes (e.g. AD/HD or psychopathy) seems to describe a natural category, a dimensional behavioural phenotype reflecting aggressive antisocial behaviours assessed by numbers of behaviours, the severity of their consequences and how early is their age at onset, which will be closely related to childhood hyperactivity, would bring conceptual clarity, and may form the basis for further probing into mental, cognitive, biological and treatment-related co-varying features.
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| 5. |
- Hofvander, Björn, et al.
(författare)
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Psychiatric and psychosocial problems in adults with normal-intelligence autism spectrum disorders.
- 2009
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Ingår i: BMC Psychiatry. - 1471-244X. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Individuals with autism spectrum disorders (ASDs) often display symptoms from other diagnostic categories. Studies of clinical and psychosocial outcome in adult patients with ASDs without concomitant intellectual disability are few. The objective of this paper is to describe the clinical psychiatric presentation and important outcome measures of a large group of normal-intelligence adult patients with ASDs. METHODS: Autistic symptomatology according to the DSM-IV-criteria and the Gillberg & Gillberg research criteria, patterns of comorbid psychopathology and psychosocial outcome were assessed in 122 consecutively referred adults with normal intelligence ASDs. The subjects consisted of 5 patients with autistic disorder (AD), 67 with Asperger's disorder (AS) and 50 with pervasive developmental disorder not otherwise specified (PDD NOS). This study group consists of subjects pooled from two studies with highly similar protocols, all seen on an outpatient basis by one of three clinicians. RESULTS: Core autistic symptoms were highly prevalent in all ASD subgroups. Though AD subjects had the most pervasive problems, restrictions in non-verbal communication were common across all three subgroups and, contrary to current DSM criteria, so were verbal communication deficits. Lifetime psychiatric axis I comorbidity was very common, most notably mood and anxiety disorders, but also ADHD and psychotic disorders. The frequency of these diagnoses did not differ between the ASD subgroups or between males and females. Antisocial personality disorder and substance abuse were more common in the PDD NOS group. Of all subjects, few led an independent life and very few had ever had a long-term relationship. Female subjects more often reported having been bullied at school than male subjects. CONCLUSION: ASDs are clinical syndromes characterized by impaired social interaction and non-verbal communication in adulthood as well as in childhood. They also carry a high risk for co-existing mental health problems from a broad spectrum of disorders and for unfavourable psychosocial life circumstances. For the next revision of DSM, our findings especially stress the importance of careful examination of the exclusion criterion for adult patients with ASDs.
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