Influence of callous-unemotional traits, neuropsychological characteristics and neurobiological markers on treatment-outcome in adolescents with disruptive behavior disorders in a closed treatmentsetting

There are various treatment programs for youth with severe conduct problems,
with the most intensive programs taking place in a closed treatment setting.
Involuntary placement in such a setting is seen as the last resort.
Sadly placement in closed setting does not always lead to a gain in
functioning. A considerable part of the treated youth continue having conduct
problems and show a great risk to develop a criminal career and psychosocial
dysfunctioning. Therefore there is an urgent need to find cues to develop and
improve treatment modalities.
There is some evidence that youth exhibiting conduct problems in combination
with specified psychopathic characteristics, called callous-unemotional traits
(CU-traits) with or without decreased (re)activity of the
Hypothalamus-Pituitary-Adrenal axis (HPA-axis) and the autonomic nervous system
(ANS) do respond less well to punishment and rewards.
Because most common treatment programs are primarily based on these principals,
the assumption can be made that within the total group of youth with conduct
problems the subgroup with CU-traits with or without decreased HPA/ANS
(re)activity will profit less from these intensive treatment programs.
Furthermore, there are recent indication that specific neuropsychological
processes can be of significance with treatment response in delinquent youth
(De Kogel 2008; Fishbein 2009). This is in line with Moffit's theory
'Developmental dual taxanomy of antisocial behavior' (Moffit 1993), in which
impaired neuropsychological functioning is characteristic for persistant
antisocial behavior. Insight into the neuropsychological characteristics of DBD
youth can contribute to more effective interventions. Also, it is plausible
that neuropsychological charachteristics have predictive value for treatment
succes.

The study proposes to gain more knowledge in the influence of
neuropsychological characteristics, CU-traits and HPA/ANS (re)activity on
treatment outcome after standardized treatment in a closed treatment setting as
well as the changeability of the last two of these factors during treatment.
With this knowledge, treatment programs can be better tuned to specific
characteristics of youngsters and will yield new insights for future research
on the development of more effective interventions in this difficultly
treatable youth.

This observational study will include all youth who are admitted to a civil
closed treatment setting during a two year period. This will lead to
approximately 200 youngsters. During their stay several characteristics will be
followed.
CU-traits, conduct problems and possible changes in these factors are measured
regularly for treatment evaluation and are collected in a standardized way.
In addition, for this study HPA/ANS (re)activity is measure directly after
admission, before and after a regular treatment(Agression Replacement Training
[ART]) and before discharge by collecting the Cortisol Awakenings Respons (CAR)
and the heart rate.
the expansion and extension will build up to 5 years research, in which a total
of 200 adolescents will participate, off which a 100 will participate in the
heartrate and neuropsychological measurments. The neuropsychological
measurements will take place just before the start of the ART.

Youth participating in the study will all get the standard treatment, just like
those who do not participate. In addition to the standard measurements,
participants will undergo a CAR and ANS (re)activity measurement for 4 times.
For the CAR a participant is asked to chew for three times an a cotton swab
within the first hour after awakening. During this first hour the participant
is not allowed to eat, drink or smoke, after the last measurement the
participant will continue with his daily activities.
For ANS (re)activity teh adolescent will be measured 3 times, through a set of
electroides they can apply to the body themselves. The neuropsychological
characteristics will be measured through a computer and will take up around 85
minutes. This will be a moment suitable to the adolescent. Considering the
nature of the measurements, the burden for the participants is neglectably
small. There are no risks connected with this study.