Antisocial behavior, psychopathic features and abnormalities in reward and punishment processing in youth

Measuring Children's Reward and Punishment Sensitivity: An Initial Psychometric Evaluation of the Contingency Response Rating Scale

Existing research shows that children's responses to rewards and punishments are essential for understanding attention-deficit/hyperactivity disorder, oppositional defiant disorder, conduct disorder, and callous-unemotional traits. The present study developed the Contingency Response Rating Scale (CRRS) to fulfill the need for a reliable and valid measure of children's contingency response style that is brief, easy to use in applied settings, and provides additional information to existing clinical measures. We examined the psychometric properties of the CRRS in a sample of 196 children (ages 5-12), most of whom were referred to evaluate attention and behavior problems in an outpatient clinic. Using principal axis factoring, we identified five factors: (a) punishment ineffectiveness, (b) reward ineffectiveness, (c) punishment dysregulation, (d) reward dysregulation, and (e) contingency insensitivity. The subscales based on these factors showed acceptable test-retest and internal consistency reliability, and scale intercorrelations varied from low to moderate. The subscales also captured significant variance not explained by child or parent demographics and were associated with measures of psychopathology and impairment. The results provide preliminary evidence that the CRRS may be a helpful tool for assessing reward and punishment sensitivity in children with attention and behavior problems.

Peer Victimization and Callous-Unemotional Traits: The Impact of Parents and Teachers

Research on the link between peer victimization and callous-unemotional (CU) traits has primarily relied on cross-sectional designs and yielded equivocal findings. In light of the poor outcomes related to peer victimization and CU traits, it is important to determine whether this link is reciprocal in nature and to identify factors that may influence its strength. Accordingly, the current study investigated the bidirectional association between peer victimization and CU traits over a 6-month period, accounting for the moderating effects of parents (i.e., support and hostility) and teachers (i.e., support and conflict). Participants included 284 third- through fifth-grade students (ages 7-12; 51.8% boys; 51.1% Hispanic) and their homeroom teachers. Children provided ratings of peer victimization, parental hostility, and parent and teacher support. Teachers provided ratings of CU traits and student-teacher conflict. A series of cross-lagged panel models were estimated. Results revealed that, at higher levels of parental hostility, peer victimization predicted increases in CU traits over time; in contrast, peer victimization predicted decreases in CU traits at lower levels of parental hostility. Surprisingly, at higher levels of teacher conflict, peer victimization predicted decreases in CU traits over time. CU traits did not interact with parent or teacher variables to predict subsequent peer victimization. Moreover, parental hostility was positively associated with subsequent peer victimization, whereas teacher support predicted decreases in victimization over time. These findings build on previous research examining environmental influences on the expression of CU traits by highlighting peer victimization and parental hostility as potential risk factors.

Decreased gray matter volume in the anterior cerebellar of attention deficit/hyperactivity disorder comorbid oppositional defiant disorder children with associated cerebellar-cerebral hyperconnectivity: insights from a combined structural MRI and resting-state fMRI study

Attention deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) are highly comorbid. Many prior investigations have found that ADHD relates to anatomical abnormalities in gray matter. The abnormal gray matter of ADHD comorbid ODD is still poorly understood. This study aimed to explore the effect of comorbid ODD on gray matter volume (GMV) and functional alterations in ADHD. All data were provided by the ADHD-200 Preprocessed Repository, including 27 ADHD-only children, 27 ADHD + ODD children, and 27 healthy controls aged 9-14 years. Voxel-based morphometry (VBM) and functional connectivity (FC) of resting-state functional magnetic resonance imaging (fMRI) were used to compare the difference in GMV and FC between ADHD + ODD, ADHD-only, and healthy children. The results showed that ADHD children with comorbid ODD had a more significant reduction in cerebellar volume, mainly in the anterior regions of the cerebellum (Cerebellum_4_5). The Cerebellum_4_5 showed increased functional connectivity with multiple cortical regions. These brain regions include numerous executive functioning (EF) and brain default mode network (DMN) nodes. The GMV abnormalities and excessive connectivity between brain regions may further exacerbate the emotional and cognitive deficits associated with ADHD.

Impaired Punishment Learning in Conduct Disorder

OBJECTIVE

Conduct disorder (CD) has been associated with deficits in the use of punishment to guide reinforcement learning (RL) and decision making. This may explain the poorly planned and often impulsive antisocial and aggressive behavior in affected youths. Here, we used a computational modeling approach to examine differences in RL abilities between CD youths and typically developing controls (TDCs). Specifically, we tested 2 competing hypotheses that RL deficits in CD reflect either reward dominance (also known as reward hypersensitivity) or punishment insensitivity (also known as punishment hyposensitivity).

METHOD

The study included 92 CD youths and 130 TDCs (aged 9-18 years, 48% girls) who completed a probabilistic RL task with reward, punishment, and neutral contingencies. Using computational modeling, we investigated the extent to which the 2 groups differed in their learning abilities to obtain reward and/or to avoid punishment.

RESULTS

RL model comparisons showed that a model with separate learning rates per contingency explained behavioral performance best. Importantly, CD youths showed lower learning rates than TDCs specifically for punishment, whereas learning rates for reward and neutral contingencies did not differ. Moreover, callous-unemotional (CU) traits did not correlate with learning rates in CD.

CONCLUSION

CD youths have a highly selective impairment in probabilistic punishment learning, regardless of their CU traits, whereas reward learning appears to be intact. In summary, our data suggest punishment insensitivity rather than reward dominance in CD. Clinically, the use of punishment-based intervention techniques to achieve effective discipline in patients with CD may be a less helpful strategy than reward-based techniques.

Deficits in emotion recognition and processing in children with high callous-unemotional traits: the role of the MAOA gene

Children with high Callous-Unemotional (CU) traits show deficits in recognizing and processing facial expressions. Alterations in emotion recognition have been linked to a higher synaptic concentration of monoaminergic neurotransmitters. The current study investigated the relationship between the MAOA-Low-activity alleles and the ability to recognize and process facial expressions in 97 male children (8-12 years old) diagnosed with disruptive behavior disorder. Participants completed a computerized emotion-recognition task while an eye-tracking system recorded the number (Fixation Count, FC) and length (Fixation Duration, FD) of fixations to the eye region of the emotional stimuli. Children with high CU traits exhibited lower scores in recognition of sadness and anger, and lower FC and FD for sadness and fear than children with low CU traits. Children carrying the MAOA-Low-activity alleles displayed lower FD for sadness, and FD and FC for fear than those carrying the MAOA-High-activity alleles. These genetic effects appeared even stronger in children with CU traits. Moderation analysis revealed that CU traits were associated with lower FC and FD for fear, and lower FD for sadness, probably due to the MAOA-Low-activity alleles. Our findings, although to be replicated, suggest MAOA-Low-activity alleles as potential genetic biomarkers to identify CU children in need of training focused on emotion processing.

Is childhood lying shaped by callous-unemotional traits or does lie-telling make children more callous-unemotional? A longitudinal between- and within-person perspective

The current study aims to advance knowledge on the causal interrelationship between childhood CU traits and lying both at a between- and a within-person perspective across a significant developmental period of mid-childhood to mid-adolescence. Cross-lagged panel models and Random-intercept cross-lagged panel models were used to investigate the prospective associations between lying and the distinct subcomponents of CU traits, including Callousness, Uncaring, and Unemotional in a sample of 719 children (T1; Mage = 10.73 years, SDage = 1.38, range = 7-15 years, 54.4% girls) across four assessment points. Results supported large vulnerability effects at the between-person level across time, indicating that CU traits predominantly influence the subsequent development of lying, with Callousness and Uncaring showing most profound effects on subsequent developmental processes of lying. At the within-person level, fluctuations in CU traits and lying were overall meaningfully related, but no causal relationship could be empirically determined. These findings provide a differentiated etiological viewpoint on the intertwinement of CU traits and lying at a young age, and underscore the importance of an early identification of children with callous and uncaring tendencies in order to prevent more persistent lying in adolescence.

Callous-unemotional Traits and Child Response to Teacher Rewards, Discipline, and Instructional Methods in Chinese Preschools: A Classroom Observation Study

Atypical responses to teacher rewards, discipline and different forms of instructional methods have been identified as potential contributors to disruptive behavior, low school engagement, and academic underachievement in children with elevated callous-unemotional (CU) traits. To date, research on CU traits in schools has relied on interview or questionnaire methods and has predominantly been conducted in Western countries. Thus, the present study aims to investigate the relationships between CU traits and children's responses to teacher rewards, discipline and instructional methods in the Chinese preschool context using classroom observation. Eight teachers (7 females, 1 male; M = 37.66 years) and 116 children (56% girls; M = 5.16 years) from two mainstream Chinese preschools participated in the study. Of the 116 eligible children, the behavior of 108 children from four classes were observed during classroom activities. Findings indicated that CU traits were not related to children's responses to discipline, nor did CU traits moderate the relationship between instructional methods and children's academic engagement. Higher CU traits predicted a greater frequency of one-to-one teacher-child interaction. Our findings offer initial insights into the potential of early school-based interventions in fostering engagement and prosocial behavior among children with CU traits. However, they also highlight the need for additional support for preschool teachers, who face the challenge of managing these high-risk children who appear to require more individual time and attention.

Functional Connectivity of the Nucleus Accumbens across Variants of Callous-Unemotional Traits: A Resting-State fMRI Study in Children and Adolescents

A large body of literature suggests that the primary (high callousness-unemotional traits [CU] and low anxiety) and secondary (high CU traits and anxiety) variants of psychopathy significantly differ in terms of their clinical profiles. However, little is known about their neurobiological differences. While few studies showed that variants differ in brain activity during fear processing, it remains unknown whether they also show atypical functioning in motivational and reward system. Latent Profile Analysis (LPA) was conducted on a large sample of adolescents (n = 1416) to identify variants based on their levels of callousness and anxiety. Seed-to-voxel connectivity analysis was subsequently performed on resting-state fMRI data to compare connectivity patterns of the nucleus accumbens across subgroups. LPA failed to identify the primary variant when using total score of CU traits. Using a family-wise cluster correction, groups did not differ on functional connectivity. However, at an uncorrected threshold the secondary variant showed distinct functional connectivity between the nucleus accumbens and posterior insula, lateral orbitofrontal cortex, supplementary motor area, and parietal regions. Secondary LPA analysis using only the callousness subscale successfully distinguish both variants. Group differences replicated results of deficits in functional connectivity between the nucleus accumbens and posterior insula and supplementary motor area, but additionally showed effect in the superior temporal gyrus which was specific to the primary variant. The current study supports the importance of examining the neurobiological markers across subgroups of adolescents at risk for conduct problems to precise our understanding of this heterogeneous population.

An 'embedded brain' approach to understanding antisocial behaviour

Antisocial behaviour (ASB) incurs substantial costs to the individual and society. Cognitive neuroscience has the potential to shed light on developmental risk for ASB, but it cannot achieve this potential in an 'essentialist' framework that focuses on the brain and cognition isolated from the environment. Here, we present the case for studying the social transactional and iterative unfolding of brain and cognitive development in a relational context. This approach, which we call the study of the 'embedded brain', is needed to fully understand how risk for ASB arises during development. Concentrated efforts are required to develop and unify methods to achieve this approach and reap the benefits for improved prevention and intervention of ASB.

Different whole-brain functional connectivity correlates of reactive-proactive aggression and callous-unemotional traits in children and adolescents with disruptive behaviors

BACKGROUND

Disruptive behavior in children and adolescents can manifest as reactive aggression and proactive aggression and is modulated by callous-unemotional traits and other comorbidities. Neural correlates of these aggression dimensions or subtypes and comorbid symptoms remain largely unknown. This multi-center study investigated the relationship between resting state functional connectivity (rsFC) and aggression subtypes considering comorbidities.

METHODS

The large sample of children and adolescents aged 8-18 years (n = 207; mean age = 13.30±2.60 years, 150 males) included 118 cases with disruptive behavior (80 with Oppositional Defiant Disorder and/or Conduct Disorder) and 89 controls. Attention-deficit/hyperactivity disorder (ADHD) and anxiety symptom scores were analyzed as covariates when assessing group differences and dimensional aggression effects on hypothesis-free global and local voxel-to-voxel whole-brain rsFC based on functional magnetic resonance imaging at 3 Tesla.

RESULTS

Compared to controls, the cases demonstrated altered rsFC in frontal areas, when anxiety but not ADHD symptoms were controlled for. For cases, reactive and proactive aggression scores were related to global and local rsFC in the central gyrus and precuneus, regions linked to aggression-related impairments. Callous-unemotional trait severity was correlated with ICC in the inferior and middle temporal regions implicated in empathy, emotion, and reward processing. Most observed aggression subtype-specific patterns could only be identified when ADHD and anxiety were controlled for.

CONCLUSIONS

This study clarifies that hypothesis-free brain connectivity measures can disentangle distinct though overlapping dimensions of aggression in youths. Moreover, our results highlight the importance of considering comorbid symptoms to detect aggression-related rsFC alterations in youths.

The association between callous-unemotional traits and substance use in childhood and adolescence: A systematic review and meta-analysis

Callous-unemotional (CU) traits are characterized by a lack of guilt and empathy, restricted affect, and low concern about performance, and are increasingly recognized as co-occurring with substance use in youth. However, there is mixed evidence concerning whether they make a unique contribution to substance use. This systematic review and meta-analysis sought to quantify the association between CU traits and substance use in childhood, accounting for potential moderators including sample characteristics (age, gender, community versus clinical/forensic samples), CU traits measure and informant, and study design (cross-sectional or longitudinal). Separate meta-analyses were conducted for alcohol, cannabis, and a substance use composite. Small, significant associations were found between CU traits and alcohol (θ = 0.17), cannabis (θ = 0.17) and the substance use composite (θ = 0.15), which were present in both community and clinical/forensic samples. Findings suggest that CU traits co-occur with a range of substance use problems, and that CU traits should be considered in assessments of youth presenting with substance use problems regardless of the nature of the setting.

Differential processing of risk and reward in delinquent and non-delinquent youth

The present study examined the behavioral and neural differences in risky decision-making between delinquent (n = 23) and non-delinquent (n = 27) youth ages 13-17 years (M = 16, SD = 0.97) in relation to reward processing. While undergoing functional neuroimaging, participants completed an experimental risk task wherein they received feedback about the riskiness of their behavior in the form of facial expressions that morphed from happy to angry. Behavioral results indicated that delinquent youth took fewer risks and earned fewer rewards on the task than non-delinquent youth. Results from whole-brain analyses indicated no group differences in sensitivity to punishments (i.e. angry faces), but instead showed that delinquent youth evinced greater neural tracking of reward outcomes (i.e. cash-ins) in regions including the ventral striatum and inferior frontal gyrus. While behavioral results show that delinquent youth were more risk-averse, the neural results indicated that delinquent youth were also more reward-driven, potentially suggesting a preference for immediate rewards. Results offer important insights into differential decision-making processes between delinquent and non-delinquent youth.

Antisocial behavior is associated with reduced frontoparietal activity to loss in a population-based sample of adolescents

BACKGROUND

Adolescent antisocial behavior (AB) is a public health concern due to the high financial and social costs of AB on victims and perpetrators. Neural systems involved in reward and loss processing are thought to contribute to AB. However, investigations into these processes are limited: few have considered anticipatory and consummatory components of reward, response to loss, nor whether associations with AB may vary by level of callous-unemotional (CU) traits.

METHODS

A population-based community sample of 128 predominantly low-income youth (mean age = 15.9 years; 42% male) completed a monetary incentive delay task during fMRI. A multi-informant, multi-method latent variable approach was used to test associations between AB and neural response to reward and loss anticipation and outcome and whether CU traits moderated these associations.

RESULTS

AB was not associated with neural response to reward but was associated with reduced frontoparietal activity during loss outcomes. This association was moderated by CU traits such that individuals with higher levels of AB and CU traits had the largest reductions in frontoparietal activity. Co-occurring AB and CU traits were also associated with increased precuneus response during loss anticipation.

CONCLUSIONS

Findings indicate that AB is associated with reduced activity in brain regions involved in cognitive control, attention, and behavior modification during negative outcomes. Moreover, these reductions are most pronounced in youth with co-occurring CU traits. These findings have implications for understanding why adolescents involved in AB continue these behaviors despite severe negative consequences (e.g. incarceration).

Neural bases of frustration-aggression theory: A multi-domain meta-analysis of functional neuroimaging studies

BACKGROUND

Early evidence suggests that unexpected non-reward may increase the risk for aggressive behaviors. Despite the growing interest in understanding brain functions that may be implicated in aggressive behaviors, the neural processes underlying such frustrative events remain largely unknown. Furthermore, meta-analytic results have produced discrepant results, potentially due to substantial differences in the definition of anger/aggression constructs.

METHODS

Therefore, we conducted a coordinate-based meta-analysis, using the activation likelihood estimation algorithm, on neuroimaging studies examining reward omission and retaliatory behaviors in healthy subjects. Conjunction analyses were further examined to discover overlapping brain activations across these meta-analytic maps.

RESULTS

Frustrative non-reward deactivated the orbitofrontal cortex, ventral striatum and posterior cingulate cortex, whereas increased activations were observed in midcingulo-insular regions. Retaliatory behaviors recruited the left fronto-insular and anterior midcingulate cortices, the dorsal caudate and the primary somatosensory cortex. Conjunction analyses revealed that both strongly activated midcingulo-insular regions.

LIMITATIONS

Spatial overlap between neural correlates of frustration and retaliatory behaviors was conducted using a conjunction analysis. Therefore, neurobiological markers underlying the temporal sequence of the frustration-aggression theory should be interpreted with caution.

CONCLUSIONS

Nonetheless, our results underscore the role of anterior midcingulate/pre-supplementary motor area and fronto-insular cortex in both frustration and retaliatory behaviors. A neurobiological framework for understanding frustration-based impulsive aggression is provided.

The computational psychiatry of antisocial behaviour and psychopathy

Antisocial behaviours such as disobedience, lying, stealing, destruction of property, and aggression towards others are common to multiple disorders of childhood and adulthood, including conduct disorder, oppositional defiant disorder, psychopathy, and antisocial personality disorder. These disorders have a significant negative impact for individuals and for society, but whether they represent clinically different phenomena, or simply different approaches to diagnosing the same underlying psychopathology is highly debated. Computational psychiatry, with its dual focus on identifying different classes of disorder and health (data-driven) and latent cognitive and neurobiological mechanisms (theory-driven), is well placed to address these questions. The elucidation of mechanisms that might characterise latent processes across different disorders of antisocial behaviour can also provide important advances. In this review, we critically discuss the contribution of computational research to our understanding of various antisocial behaviour disorders, and highlight suggestions for how computational psychiatry can address important clinical and scientific questions about these disorders in the future.

Parent Training Adapted to the Needs of Children With Callous-Unemotional Traits: A Randomized Controlled Trial

Callous-unemotional (CU) traits designate a distinct subgroup of children with early-starting, stable, and aggressive conduct problems. Critically, traditional parenting interventions often fail to normalize conduct problems among this subgroup. The aim of this study was to test whether parent-child interaction therapy (PCIT) adapted to target distinct deficits associated with CU traits (PCIT-CU) produced superior outcomes relative to standard PCIT. In this proof-of-concept trial, 43 families with a 3- to 7-year-old child (M age = 4.84 years, SD = 1.12, 84% male) with clinically significant conduct problems and elevated CU traits were randomized to receive standard PCIT (n = 21) or PCIT-CU (n = 22) at an urban university-based research clinic. Families completed five assessments measuring child conduct problems, CU traits, and empathy. Parents in both conditions reported good treatment acceptability and significantly improved conduct problems and CU traits during active treatment, with no between-group differences. However, linear mixed-effects models showed treatment gains in conduct problems deteriorated for children in standard PCIT relative to those in PCIT-CU during the 3-month follow-up period (ds = 0.4-0.7). PCIT-CU shows promise for sustaining improvements in conduct problems for young children with conduct problems and CU traits, but requires continued follow-up and refinement.

Loss and Frontal Striatal Reactivities Characterize Alcohol Use Severity and Rule-Breaking Behavior in Young Adult Drinkers

BACKGROUND

Alcohol misuse is associated with externalizing behaviors, including rule breaking. Studies have implicated altered reward processing in externalizing behaviors and alcohol misuse. Here, we investigated whether reward or punishment reactivity more significantly influenced alcohol use severity and rule-breaking behavior in young adult drinkers.

METHODS

We curated data from the Human Connectome Project and identified 181 binge (132 men) and 288 nonbinge (97 men) drinkers performing a gambling task during brain imaging. Alcohol use severity was quantified by the first principal component of principal-component analysis of all drinking measures. We analyzed the imaging data using published routines and evaluated the results at a corrected threshold. We examined the interrelationship between imaging and clinical metrics with mediation and path analyses.

RESULTS

Compared with nonbingers, bingers showed more severe rule-breaking behavior and responded significantly faster during post-loss than during post-win trials. Compared with nonbingers, bingers demonstrated greater inferior/middle frontal gyrus and cerebellum activations in loss-predominating blocks but no differences in regional responses to win-predominating blocks, relative to an interblock baseline. The right caudate body showed loss reactivity that was positively correlated with the rule-breaking score. No regional responses to wins were significantly correlated with the rule-breaking score. Mediation and path analyses demonstrated significant models with inferior/middle frontal gyrus and caudate reactivity to loss interrelating rule breaking and alcohol use severity.

CONCLUSIONS

Punishment rather than reward reactivity was associated with alcohol use severity and rule breaking in young adults. The findings highlight the roles of negative emotions in psychological models of externalizing behaviors and alcohol misuse.

The Impact of Irritability and Callous Unemotional Traits on Reward Positivity in Youth with ADHD and Conduct Problems

Children with attention-deficit/hyperactivity disorder (ADHD) and conduct problems exhibit significant variability in functioning and treatment response that cannot be fully accounted for by differences in symptom severity. Reward responsivity (RR) is a potential transdiagnostic means to account for this variability. Irritability and callous-unemotional (CU) traits moderate associations between both ADHD and conduct problems with multiple realms of functioning. Both are theorized to be associated with RR, but associations in clinical samples are unknown. In 48 youth ages 5-12 with ADHD referred for treatment of conduct problems, we examined RR using a guessing task where participants select a door icon to win and lose money. Analyses focused on the reward positivity (RewP) event-related potential in response to gain and loss feedback, which reliably peaks approximately 300 ms after feedback. Frequentist and Bayesian approaches assessed main effects of ADHD, Conduct Disorder (CD) and non-irritable Oppositional Defiant Disorder (ODD) symptoms with RR, plus interactions between symptoms and affective dimensions (irritability, CU). CD and ODD were hypothesized to be associated with altered RR, with irritability and CU moderating these associations. Across models, a reliable CD x irritability interaction emerged, indicating enhanced RewP when irritability was elevated and CD symptoms were low. CU did not moderate any associations with RR, and little support was found for associations between RR and other symptom domains. As neural response to reward varied with levels of irritability and CD symptoms, RR may hold potential as a clinically-relevant biomarker in youth with ADHD and conduct problems.

Sex Moderates Reward- and Loss-Related Neural Correlates of Triarchic-Model Traits and Antisocial Behavior

Abnormalities in responses to reward and loss are implicated in the etiology of antisocial behavior and psychopathic traits. While there is evidence for sex differences in neural response to reward and loss, it remains unclear how sex differences may moderate links between these neural responses and the phenotypic expression of antisocial behavior and psychopathic traits. This study examined sex differences in associations of neural response to reward and loss with antisocial personality symptoms and psychopathic traits. Functional neuroimaging data were collected during a monetary incentive delay task from 158 participants. Among males, during loss anticipation, activation in the left nucleus accumbens was negatively associated with antisocial behavior. Among females, during loss feedback, activation in the left nucleus accumbens and left amygdala was negatively associated with antisocial behavior. These results suggest that phenotypic sex differences in psychopathic traits and antisocial behavior may in part be attributable to different etiological pathways.

Facial Affect Sensitivity Training for Young Children with Emerging CU Traits: An Experimental Therapeutics Approach

OBJECTIVE

This article delineates best practices in the application of the experimental therapeutics framework for evaluating interventions within the context of randomized controlled trials (RCTs), offering a methodological primer and guiding framework for this approach. We illustrate these practices using an ongoing clinical trial conducted within the framework of a National Institute of Mental Health exploratory phased-innovation award for the development of psychosocial therapeutic interventions for mental disorders (R61/R33), describing the implementation of a novel "Facial Affect Sensitivity Training" (FAST) intervention for children with callous-unemotional (CU) traits. CU traits (e.g., lack of guilt or remorse, low empathy, shallow affect) are an established risk factor for persistent and severe youth misconduct, which reflect impairment in identified neurocognitive mechanisms that interfere with child socialization, and predict poor treatment outcomes, even with well-established treatments for disruptive behavior.

METHOD

We outline the stages, goals, and best practices for an experimental therapeutics framework. In the FAST trial, we assert that impaired sensitivity for emotional distress cues (fear and/or sadness) is mechanistically linked to CU traits in children, and that by targeting sensitivity to facial affect directly via a computerized automated feedback and incentive system, we can exert downstream effects on CU traits.

RESULTS

In the context of an open pilot trial, we found preliminary support for feasibility and mechanism engagement using FAST.

CONCLUSIONS

We summarize pilot study limitations and how they are being addressed in the R61/R33 RCTs, as well as challenges and future directions for psychosocial experimental therapeutics.

Sensitization-based risk for substance abuse in vulnerable individuals with ADHD: Review and re-examination of evidence

Evidence of sensitization following stimulants administration in humans is just emerging, which prevents reaching more definitive conclusions in favor or against a purported protective role of stimulant treatments for ADHD for the development of substance use disorders. Existing evidence from both animal and human research suggest that stimulants produce neurophysiological changes in the brain reward system, some of which could be persistent. This could be relevant in choosing optimal treatments for young patients with ADHD who have additional clinical risk factors for substance abuse (e.g. conduct disorder (CD) and/or familial addictions). Here we stipulate that, while the majority of youth with ADHD greatly benefit from treatments with stimulants, there might be a subpopulation of individuals whose neurobiological profiles may confer risk for heightened vulnerability to the effects of stimulants on the responsiveness of the brain reward system. We propose that focused human research is needed to elucidate the unknown effects of prolonged stimulant exposure on the neurophysiology of the brain reward system in young patients with ADHD.

A three-factor model of common early onset psychiatric disorders: temperament, adversity, and dopamine

Commonly comorbid early onset psychiatric disorders might reflect the varying expression of overlapping risk factors. The mediating processes remain poorly understood, but three factors show some promise: adolescent externalizing traits, early life adversity, and midbrain dopamine autoreceptors. To investigate whether these features acquire greater predictive power when combined, a longitudinal study was conducted in youth who have been followed since birth. Cohort members were invited to participate based on externalizing scores between 11 to 16 years of age. At age 18 (age 18.5 ± 0.6 y.o.), 52 entry criteria meeting volunteers had a 90-min positron emission tomography scan with [¹⁸F]fallypride, completed the Childhood Trauma Questionnaire, and were assessed with the Structured Clinical Interview for DSM-5. The three-factor model identified those with a lifetime history of DSM-5 disorders with an overall accuracy of 90.4% (p = 2.4 × 10^-5) and explained 91.5% of the area under the receiver operating characteristic curve [95% CI: .824, 1.000]. Targeting externalizing disorders specifically did not yield a more powerful model than targeting all disorders (p = 0.54). The model remained significant when including data from participants who developed their first disorders during a three-year follow-up period (p = 3.5 × 10^-5). Together, these results raise the possibility that a combination of temperamental traits, childhood adversity, and poorly regulated dopamine transmission increases risk for diverse, commonly comorbid, early onset psychiatric problems, predicting this susceptibility prospectively.

The origins of evil: From lesions to the functional architecture of the antisocial brain

In the past decades, a growing body of evidence has suggested that some individuals may exhibit antisocial behaviors following brain lesions. Recently, some authors have shown that lesions underpinning antisocial behaviors may disrupt a particular brain network during resting-state. However, it remains unknown whether these brain lesions may alter specific mental processes during tasks. Therefore, we conducted meta-analytic co-activation analyses on lesion masks of 17 individuals who acquired antisocial behaviors following their brain lesions. Each lesion mask was used as a seed of interest to examine their aberrant co-activation network using a database of 143 whole-brain neuroimaging studies on antisocial behaviors (n = 5,913 subjects). We aimed to map the lesion brain network that shows deficient activity in antisocial population against a null distribution derived from 655 control lesions. We further characterized the lesion-based meta-analytic network using term-based decoding (Neurosynth) as well as receptor/transporter density maps (JuSpace). We found that the lesion meta-analytic network included the amygdala, orbitofrontal cortex, ventro- and dorso-medial prefrontal cortex, fusiform face area, and supplementary motor area (SMA), which correlated mainly with emotional face processing and serotoninergic system (5-HT_1A and 5-HTT). We also investigated the heterogeneity in co-activation networks through data-driven methods and found that lesions could be grouped in four main networks, encompassing emotional face processing, general emotion processing, and reward processing. Our study shows that the heterogeneous brain lesions underpinning antisocial behaviors may disrupt specific mental processes, which further increases the risk for distinct antisocial symptoms. It also highlights the importance and complexity of studying brain lesions in relationship with antisocial behaviors.

Rumination as a transdiagnostic process: The role of rumination in relation to antisocial and borderline symptoms

The present study examined the influence of several forms of repetitive negative thinking on antisocial and borderline symptoms to identify underlying mechanisms that may contribute to the presentation and cooccurrence of these symptoms. Participants (N = 403), completed the Personality Assessment Inventory, the Personality Diagnostic Questionnaire-4, and several measures of rumination/worry. Path analyses were conducted in which different forms of rumination/worry predicted antisocial and borderline symptoms across two personality disorder measures. Across both models tested, anger rumination emerged as the strongest predictor of both antisocial and borderline symptoms while worry negatively predicted antisocial symptoms. Rumination and worry explained substantially more variance in borderline symptoms compared to antisocial symptoms. This study is the first study to examine antisocial symptoms in relation to forms of rumination/worry and highlights the differential relations of rumination/worry to antisocial and borderline symptoms using a multi-measure approach. Further, this study highlights the importance of examining types of repetitive negative thinking, specifically rumination, as potential transdiagnostic processes.

Neural response to monetary loss among youth with disruptive behavior disorders and callous-unemotional traits in the ABCD study

•

We leveraged the ABCD Study to derive phenotypically narrow groups of youth with DBD in the largest loss processing functional MRI study to date.

•

We examined neural activity to the anticipation and receipt of monetary loss using group, dimensional, and network-level analyses.

•

There were no significant differences in brain activity to loss anticipation or receipt among youth with DBD with or without CU traits.

•

Null findings were confirmed with and without covariates, using alternative grouping approaches, in dimensional models, and within network-level analyses.

Etiological models highlight reduced punishment sensitivity as a core risk factor for disruptive behavior disorders (DBD) and callous-unemotional (CU) traits. The current study examined neural sensitivity to the anticipation and receipt of loss, one key aspect of punishment sensitivity, among youth with DBD, comparing those with and without CU traits. Data were obtained from the Adolescent Brain and Cognitive Development (ABCD)^SM Study (N = 11,874; Mage = 9.51; 48% female). Loss-related fMRI activity during the monetary incentive delay task was examined across 16 empirically-derived a priori brain regions (e.g., striatum, amygdala, insula, anterior cingulate cortex, medial prefrontal cortex) and compared across the following groups: (1) typically developing (n = 693); (2) DBD (n = 995), subdivided into those (3) with CU traits (DBD + CU, n = 198), and (4) without CU traits (DBD-only, n = 276). Latent variable modeling was also employed to examine network-level activity. There were no significant between-group differences in brain activity to loss anticipation or receipt. Null findings were confirmed with and without covariates, using alternative grouping approaches, and in dimensional models. Network-level analyses also demonstrated comparable activity across groups during loss anticipation and receipt. Findings suggest that differences in punishment sensitivity among youth with DBD are unrelated to loss anticipation or receipt. More precise characterizations of other aspects punishment sensitivity are needed to understand risk for DBD and CU traits.

Heterogeneity Within Youth With Childhood-Onset Conduct Disorder in the ABCD Study

The purpose of this study was to examine if personality traits can be used to characterize subgroups of youth diagnosed with childhood-onset conduct disorder (CD). Participants were 11,552 youth from the Adolescent Brain Cognitive Development study. Data used in this report came from doi: 10.15154/1504041 (M age 9.92; 45.3% female, 49.6% white, 19.0% Hispanic). A subset of this sample (n = 365) met criteria for CD. Latent profile analyses (LPA) were performed on this subgroup (n = 365) to define profiles of individuals with CD based on self-report measures of impulsivity, punishment sensitivity, reward response, and callous-unemotional traits. Follow up analyses determined if these groups differed on clinically relevant variables including psychopathology, environmental risk factors, social risk factors, and neurocognitive functioning. Participants with a CD diagnosis scored significantly higher on psychological, environmental, social, and neurocognitive risk factors. The LPA revealed three unique profiles, which differed significantly on liability for broad psychopathology and domain-specific liability for externalizing psychopathology but were largely matched on environmental and social risk factors. These unique configurations provide a useful way to further parse clinically relevant subgroups within youth who meet criteria for childhood-onset CD, setting the stage for prospective longitudinal research using these latent profiles to better understand the development of youth with childhood-onset CD.

Linking RDoC and HiTOP: A new interface for advancing psychiatric nosology and neuroscience

The Research Domain Criteria (RDoC) and the Hierarchical Taxonomy of Psychopathology (HiTOP) represent major dimensional frameworks proposing two alternative approaches to accelerate progress in the way psychopathology is studied, classified, and treated. RDoC is a research framework rooted in neuroscience aiming to further the understanding of transdiagnostic biobehavioral systems underlying psychopathology and ultimately inform future classifications. HiTOP is a dimensional classification system, derived from the observed covariation among symptoms of psychopathology and maladaptive traits, which seeks to provide more informative research and treatment targets (i.e., dimensional constructs and clinical assessments) than traditional diagnostic categories. This article argues that the complementary strengths of RDoC and HiTOP can be leveraged in order to achieve their respective goals. RDoC's biobehavioral framework may help elucidate the underpinnings of the clinical dimensions included in HiTOP, whereas HiTOP may provide psychometrically robust clinical targets for RDoC-informed research. We present a comprehensive mapping between dimensions included in RDoC (constructs and subconstructs) and HiTOP (spectra and subfactors) based on narrative review of the empirical literature. The resulting RDoC-HiTOP interface sheds light on the biobehavioral correlates of clinical dimensions and provides a broad set of dimensional clinical targets for etiological and neuroscientific research. We conclude with future directions and practical recommendations for using this interface to advance clinical neuroscience and psychiatric nosology. Ultimately, we envision that this RDoC-HiTOP interface has the potential to inform the development of a unified, dimensional, and biobehaviorally-grounded psychiatric nosology.

Reward Processing in Children With Disruptive Behavior Disorders and Callous-Unemotional Traits in the ABCD Study

OBJECTIVE

Disrupted reward processing is implicated in the etiology of disruptive behavior disorders (DBDs) and callous-unemotional traits. However, neuroimaging investigations of reward processing underlying these phenotypes remain sparse. The authors examined neural sensitivity in response to reward anticipation and receipt among youths with DBDs, with and without callous-unemotional traits.

METHODS

Data were obtained from the Adolescent Brain and Cognitive Development Study (mean age=9.51 years [SD=0.50]; 49% female). Reward-related activation during the monetary incentive delay task was examined across 16 brain regions, including the amygdala, anterior cingulate cortex (ACC), nucleus accumbens (NAcc), and orbitofrontal cortex (OFC). Latent variable modeling was used to examine network-level coactivation. The following diagnostic groups were compared: typically developing youths (N=693) and youths with DBDs (N=995), subdivided into those with callous-unemotional traits (DBD+CU, N=198) and without callous-unemotional traits (DBD only, N=276).

RESULTS

During reward anticipation, youths in the overall DBD group (with and without callous-unemotional traits) showed decreased dorsal ACC activation compared with typically developing youths. The DBD-only group exhibited reduced ventral and dorsal striatal activity compared with the DBD+CU and typically developing groups. During reward receipt, youths with DBDs showed increased cortical (e.g., OFC) and subcortical (e.g., NAcc) regional activation compared with typically developing youths. The DBD+CU group demonstrated greater activation in several regions compared with those in the typically developing (e.g., amygdala) and DBD-only (e.g., dorsal ACC) groups. At the network level, the DBD-only group showed reduced anticipatory reward activation compared with the typically developing and DBD+CU groups, whereas youths in the DBD+CU group showed increased activation during reward receipt compared with those in the typically developing group.

CONCLUSIONS

These findings advance our understanding of unique neuroetiologic pathways to DBDs and callous-unemotional traits.

Reward and Punishment Sensitivity are Associated with Cross-disorder Traits

Reversal learning deficits following reward and punishment processing are observed across disruptive behaviors (DB) and attention-deficit/hyperactivity disorder (ADHD), and have been associated with callous-unemotional (CU) traits. However, it remains unknown to what extent these altered reinforcement sensitivities are linked to the co-occurrence of oppositional traits, ADHD symptoms, and CU traits. Reward and punishment sensitivity and perseverative behavior were therefore derived from a probabilistic reversal learning task to investigate reinforcement sensitivity in participants with DB (n=183, ODD=62, CD=10, combined=57, age-range 8-18), ADHD (n=144, age-range 11-28), and controls (n=191, age-range 8-26). The SNAP-IV and Conners rating scales were used to assess oppositional and ADHD traits. The Inventory of CU traits was used to assess CU traits. Decreased reward sensitivity was associated with ADHD symptom severity (p=0.018) if corrected for oppositional symptoms. ADHD symptomatology interacted with oppositional behavior on perseveration (p=0.019), with the former aggravating the effect of oppositional behavior on perseveration and vice versa. Within a pooled sample, reversal learning alterations were associated with the severity of ADHD symptoms, underpinned by hyposensitivity to reward and increased perseveration. These results show ADHD traits, as opposed to oppositional behavior and CU traits, is associated with decreased reward-based learning in adolescents and adults.

The ups and downs of relating nondrug reward activation to substance use risk in adolescents

Purpose of review

A wealth of epidemiological and cohort research, together with a healthy dose of anecdote, has characterized late-adolescence and emerging adulthood as a time of increased substance use and other risky behaviors. This review will address whether differences between adolescents or between adolescents and other age groups in dopaminergic mesolimbic recruitment by (non-drug) rewards inferred from functional magnetic resonance imaging (fMRI) could partially explain morbidity and mortality from risky-behavior-related causes in adolescents.

Recent findings

Recent findings do not suggest a definitive directionality with regard to whether increased vs decreased mesolimbic responsiveness to nondrug rewards correlates with real-world risk-taking. Inconsistent relationships between reward-activation and real-world risky behavior in these reports reflect in part methodological differences as well as conceptual differences between populations in terms of whether tepid mesolimbic recruitment by rewards is a marker of psychiatric health.

Summary

There are several potential reasons why the directionality of relationships between reward-elicited brain activation and substance use risk (specifically) might differ. These factors include differences between adolescents in histories/exposure of substance use, motivation for substance use, the component of the instrumental behavior being studied, and the cognitive demands of the incentive tasks. Systematic manipulation of these discrepant study factors might offer a way forward to clarify how motivational neurocircuit function relates to addiction risk in adolescents.

Human social defeat and approach-avoidance: Escalating social-evaluative threat and threat of aggression increases social avoidance

Basic research on avoidance by Murray Sidman laid the foundation for advances in the classification, conceptualization and treatment of avoidance in psychological disorders. Contemporary avoidance research is explicitly translational and increasingly focused on how competing appetitive and aversive contingencies influence avoidance. In this laboratory investigation, we examined the effects of escalating social-evaluative threat and threat of social aggression on avoidance of social interactions. During social-defeat learning, 38 adults learned to associate 9 virtual peers with an increasing probability of receiving negative evaluations. Additionally, 1 virtual peer was associated with positive evaluations. Next, in an approach-avoidance task with social-evaluative threat, 1 peer associated with negative evaluations was presented alongside the peer associated with positive evaluations. Approaching peers produced a positive or a probabilistic negative evaluation, while avoiding peers prevented a negative evaluation (and forfeited a positive evaluation). In an approach-avoidance task with social aggression, virtual peers gave and took money away from participants. Escalating social-evaluative threat and aggression increased avoidance, ratings of feeling threatened and threat expectancy and decreased ratings of peer favorableness. These findings underscore the potential of coupling social defeat and approach-avoidance paradigms for translational research on the neurobehavioral mechanisms of social approach-avoidance decision-making and anxiety.

Neurofunctional abnormalities in antisocial spectrum: A meta-analysis of fMRI studies on Five distinct neurocognitive research domains

Past functional magnetic resonance imaging on antisocial subjects have shown important inconsistencies and methodological problems (e.g. heterogeneity in fMRI tasks domain, small sample sizes, analyses on regions-of-interest). We aimed to conduct a meta-analysis of whole-brain fMRI studies on antisocial individuals based on distinct neurocognitive domains. A voxel-based meta-analysis via permutation of subject images (SDM-PSI) was performed on studies using fMRI tasks in the domains of acute threat response, cognitive control, social cognition, punishment and reward processing. Overall, 83 studies were retrieved. Using a liberal statistical threshold, several key regions were identified in the meta-analysis, principally during acute threat response, social cognition and cognitive control tasks. Additionally, we observed that the right amygdala was negatively associated with both callous-unemotional traits and severity of antisocial behaviors, in meta-analyses on region-of-interest and on dimensional studies, respectively. The findings show that the most prominent functional brain deficits arise during acute threat response, social cognitions and cognitive control neurocognitive domains. These results provide substantial insights for our understanding of aberrant neural processing across specific contexts.

Examining cognitive control and reward interactions in adolescent externalizing symptoms

During adolescence, rapid development and reorganization of the dopaminergic system supports increasingly sophisticated reward learning and the ability to exert behavioral control. Disruptions in the ability to exert control over previously rewarded behavior may underlie some forms of adolescent psychopathology. Specifically, symptoms of externalizing psychopathology may be associated with difficulties in flexibly adapting behavior in the context of reward. However, the direct interaction of cognitive control and reward learning in adolescent psychopathology symptoms has not yet been investigated. The present study used a Research Domain Criteria framework to investigate whether behavioral and neuronal indices of inhibition to previously rewarded stimuli underlie individual differences in externalizing symptoms in N = 61 typically developing adolescents. Using a task that integrates the Monetary Incentive Delay and Go-No-Go paradigms, we observed a positive association between externalizing symptoms and activation of the left middle frontal gyrus during response inhibition to cues with a history of reward. These associations were robust to controls for internalizing symptoms and neural recruitment during inhibition of cues with no reward history. Our findings suggest that inhibitory control over stimuli with a history of reward may be a useful marker for future inquiry into the development of externalizing psychopathology in adolescence.

Differential Behavioral and Neural Profiles in Youth With Conduct Problems During Risky Decision-Making

Neuroimaging work has examined neural processes underlying risk taking in adolescence, yet predominantly in low-risk youth. To determine whether we can extrapolate from current neurobiological models, this functional magnetic resonance imaging study investigated risk taking and peer effects in youth with conduct problems (CP; N = 19) and typically developing youth (TD; N = 25). Results revealed higher real-life risk taking, lower risky decisions, and no peer effects on a risk-taking task in CP youth. CP youth showed greater ventral striatum (VS) activity during safe than risky decisions, whereas TD youth showed greater VS activation during risky decisions. Differential VS activity explained higher real-life risk taking in CP youth. Findings provide preliminary evidence that risk-taking behavior in youth with CD problems is characterized by differential neural patterns.

Effects of Behavioral Treatment Modified to Fit Children with Conduct Problems and Callous-Unemotional (CU) Traits

Research suggests that children with conduct problems (CP) and callous-unemotional (CU) traits show a diminished response to behavior therapy, perhaps due to a reward-oriented, punishment insensitive learning style. Children with CP and CU may benefit from personalizing behavioral treatment for them by emphasizing rewards and de-emphasizing punishments. This hypothesis was tested in a sample of 46 children (78.3% boys), ages 7.0 to 12.6 years (M = 9.3, SD = 1.4). All participants met criteria for ODD and ADHD and 63% also met criteria for CD. Participants were oversampled for high CU, but CU scores ranged from average to high. Children received four weeks of modified behavior therapy that emphasized rewards and de-emphasized punishments and four weeks of treatment as usual, which was standard behavior therapy that balanced rewards and punishments. Treatments were implemented in a summer treatment program and compared using a within-subjects design, with order of treatment counterbalanced. Disruptive behavior was equal or slightly higher in modified behavior therapy than in standard behavior therapy on point system measures, but lower on parent weekly ratings. End of treatment ratings showed both treatments produced significant improvements compared to pre-treatment ratings but did not differ from each other. Personalizing behavior therapy for children with CP and CU produced inconsistent findings relative to standard behavior therapy. Behavior therapy is likely to be a necessary part of treatment for children with CP and CU, but treatment personalization efforts may provide some benefit by addressing other deficits shown by these children.

Callous-Unemotional Traits Among Children and Adolescents in Asian Cultures: A Systematic Review

Considerable evidence now exists for callous and unemotional (CU) traits as markers for a high-risk pathway to child and adolescent conduct problems implicating unique risk processes and treatment needs, but research has been limited largely to Western countries. We review the evidence base related to CU traits in Asian countries that has emerged in recent years, with respect to four key questions. Specifically, are higher CU traits among Asian children and adolescents associated with (1) increased severity of conduct problems; (2) similar neurodevelopmental and neurocognitive correlates as reported in Western countries; (3) similar environmental risk factors as reported in Western countries; and (4) poorer treatment outcomes? A systematic search identified 28 studies that have reported on child and adolescent CU traits in Asian countries. Consistent with Western samples, CU traits were associated with individual risk factors including atypical neural activation during cognitive tasks and poor empathy, as well as parenting risk factors. CU traits were also positively associated with most measures of conduct problems. Differences from findings in Western samples, however, emerged for areas such as correlates of reactive aggression and delinquent peer influence. Treatment has been investigated in only one study to date and is therefore a high priority for future research. The limitations of existing evidence are addressed along with key directions for future cross-cultural research, including measurement research with children and adolescents.

The Psychosocial Outcome of Conduct and Oppositional Defiant Disorder in Children With Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) is one of the most common mental disorders diagnosed in children below the age of 12 years. It is characterized by hyperactivity, inattention, and impulsive behavior. ADHD affects the social, academic, and psychological aspects of children and adolescents. Children with ADHD struggle with school tasks and performance. They have lower grades than their peers and have difficulties interacting with their friends.

Oppositional defiant disorder (ODD) is a mental disorder characterized by disruptive behavior, a pattern of angry and irritable mood, argumentative, and vindictive behavior. Children with ODD struggle with forming friendships and have problems at school. Conduct disorder (CD) is divided into the childhood onset and the adolescent onset types. The childhood onset is associated with poor outcomes in adulthood, an increase in criminal behavior, violence, and progression to antisocial behavior. Children with CD are at increased risk for substance use disorders (SUD) and antisocial personality disorder. 

The current literature review is aiming to provide an overview of the psychosocial impact of comorbid ODD and CD in children with ADHD. The results of this study review showed the comorbidity of ODD and CD is very strong. ODD is a strong predictor of CD in boys. The presence of comorbid ODD and ADHD in children is a significant predictor of adolescent onset CD. The comorbidity of ADHD with ODD and CD worsens symptom severity and is associated with high psychosocial dysfunction. Children with ADHD and comorbid ODD and CD have difficulties with school, friends, and trouble with the police. 

Reward processing and psychopathic traits in children

Growing evidence has suggested that the mechanisms underlying the 3 dimensions of psychopathic traits, including grandiose-manipulative, callous-unemotional, and daring-impulsive, are different. As yet, the neurobiological correlates of each dimension have not been fully understood. In this study, we examined if reward processing deficits were differentially associated with these traits, and whether social adversity moderated these relationships. Pre-ejection period (PEP) was assessed in children between 8 and 10 years of age from the community (N = 340, M_age = 9.06, SD = .60; 48.2% boys) while they were completing a reward task, and the caregivers rated children's psychopathic traits. Results indicated that (a) high callous-unemotional traits were associated with less PEP shortening, reflecting reward hyporesponsivity, at low levels of social adversity, and more PEP shortening, indicating hyperresponsivity, at high levels of social adversity, (b) high daring-impulsive traits were associated with hyperresponsivity at low levels of adversity only, and (c) grandiose-manipulative traits were not linked to reward processing deficits. Findings provide further evidence that different etiologies may underlie various dimensions of psychopathic traits and highlight the important role of psychosocial factors in understanding the neurobiological mechanism of youth psychopathy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Internet-Delivered Parent Training for Preschoolers with Conduct Problems: Do Callous-Unemotional Traits Moderate Efficacy and Engagement?

Recent efforts to improve access to evidence-based parent training programs using online delivery have largely neglected findings that young children with callous-unemotional (CU)-type conduct problems receive less benefit from parent training than children with conduct problems alone. The current study aimed to examine the moderating effect of child CU traits on efficacy and engagement outcomes associated with Internet-delivered Parent-Child Interaction Therapy (iPCIT) versus standard, clinic-based PCIT. Forty families (57.6% non-Hispanic Caucasian) with a 3-5 year-old (M = 3.95 years, SD = 0.9; 83.5% boys) child with a disruptive behavior disorder were randomized to either iPCIT or clinic-based PCIT. Families participated in four assessments across time; child conduct problems, global functioning and treatment responder status, and parent-rated treatment satisfaction were measured. Analyses revealed that the negative influence of CU traits on functional gains was not uniform across treatment formats. Specifically, the detrimental effect of CU traits on functional gains was significantly more pronounced among children treated with iPCIT than clinic-based PCIT. CU traits also predicted lower parental treatment satisfaction across delivery formats, but this effect was more pronounced among iPCIT parents. In contrast, CU traits did not moderate differential effects across iPCIT and clinic-based PCIT for conduct problem severity or treatment response status. Findings suggest that iPCIT is a promising treatment option for early conduct problems, particularly when access-to-care barriers exist, but that further research is needed to determine whether strategic adaptations to online programs can more optimally address the distinct needs of children with clinically significant CU traits.

Pupil Response to Affective Stimuli: a Biomarker of Early Conduct Problems in Young Children

Childhood conduct problems have been associated with reduced autonomic arousal to negative cues indicative of an insensitivity to aversive stimuli, with mixed evidence in response to positive cues. Autonomic arousal to affective stimuli has traditionally been measured through galvanic skin responses and heart-rate, despite evidence that pupillometry is more reliable and practically beneficial (i.e., no wires are attached to the participant). The current study is the first to examine abnormal pupillary responsivity to affective stimuli as a biomarker for childhood conduct problems. We measured pupil reactivity to negative, positive and neutral images in 131 children aged 4-7 years, who were referred by their teachers for being at risk of future psychopathology. We assessed relationships between pupil response to the images and teacher-rated scores on the Strengths and Difficulties Questionnaire (SDQ), which indexed child conduct problems and their overlapping emotional, behavioural and social difficulties. Reduced pupil dilation to negative images was associated with significantly increased conduct, hyperactivity, emotional and peer problems, as well as reduced prosocial behaviour. Composite scores for disruptive behaviour and emotional difficulties both uniquely predicted blunted pupil response to negative threat stimuli; there were no relations with pupil responses to positive images. These findings highlight that blunted pupil responsivity to negative stimuli serves as a biomarker for early disruptive behavioural problems and affective difficulties. Pupillometry offers an inexpensive, fast and non-intrusive measure to help identify children who are showing early disruptive behaviour or experiencing affective difficulties, which can provide opportunities for preventative intervention to avoid further psychopathology.

Design Fluency in Children with ADHD and Comorbid Disorders

BACKGROUND

Attention deficit/hyperactivity disorder (ADHD) is often associated with frontal executive impairment in children. Oppositional defiant disorder (ODD) and anxiety disorders (AD) frequently accompany ADHD, but the impact of these comorbid disorders on cognition remains elusive. The five-point test (FPT), a design fluency task, has been shown to be sensitive to neurological damage, specifically to frontal lobe lesions in patients with brain injuries. The purpose of this study was to compare the performances of neurotypical children with that of children with ADHD, ADHD-ODD, and ADHD-AD on the FPT in order to examine whether these groups could be distinguished from one another based on their cognitive profile.

METHODS

A total of 111 children aged 8 to 11 years old participated in the study. Six measures from the FPT were used to characterize their performance.

RESULTS

Statistically significant differences between groups were observed for five of the six FPT measures. Essentially, children with ADHD-ODD made more repeated designs than the three other groups (control p > 0.001, ADHD p = 0.008, ADHD-AD p = 0.008), while children with ADHD-AD produced fewer total and correct designs than the control and ADHD groups (p = 0.009).

CONCLUSIONS

This suggests that comorbidities have an additive impact on the cognitive profile of children with ADHD. Design fluency may be a sensitive measure for capturing the subtle cognitive deficits that are likely to be involved in these disorders.

Altered brain morphology in boys with attention deficit hyperactivity disorder with and without comorbid conduct disorder/oppositional defiant disorder

About 50% of attention deficit hyperactivity disorder (ADHD) patients suffer from comorbidity with oppositional defiant disorder/conduct disorder (ODD/CD). Most previous studies on structural morphology did not differentiate between pure (ADHD-only) and comorbid ADHD (ADHD+ODD/CD). Therefore, we aimed to investigate the structural profile of ADHD-only versus ADHD+ODD/CD spanning the indices subcortical and cortical volume, cortical thickness, and surface area. We predicted a reduced total gray matter, striatal, and cerebellar volume in both patient groups and a reduced amygdalar and hippocampal volume for ADHD+ODD/CD. We also explored alterations in prefrontal volume, thickness, and surface area. We acquired structural images from an adolescent sample ranging from 11 to 17 years, matched with regard to age, pubertal status, and IQ-including 36 boys with ADHD-only, 26 boys with ADHD+ODD/CD, and 30 typically developing (TD) boys. We analyzed structural data with FreeSurfer. We found reductions in total gray matter and total surface area for both patient groups. Boys with ADHD+ODD/CD had a thicker cortex than the other groups in a right rostral middle frontal cluster, which was related to stronger ODD/CD symptoms, even when controlling for ADHD symptoms. No group differences in local cortical volume or surface area emerged. We demonstrate the necessity to carefully differentiate between ADHD and ADHD+ODD/CD. The increased rostral middle frontal thickness might hint at a delayed adolescent cortical thinning in ADHD+ODD/CD. Patients with the double burden ADHD and ODD or CD seem to be even more affected than patients with pure ADHD.

Investigating Sex Differences in Emotion Recognition, Learning, and Regulation Among Youths With Conduct Disorder

OBJECTIVE

Conduct disorder (CD) is a serious neurodevelopmental disorder marked by notably higher prevalence rates for boys than girls. Converging evidence suggests that CD is associated with impairments in emotion recognition, learning, and regulation. However, it is not known whether there are sex differences in the relationship between CD and emotion dysfunction. Prior studies on emotion functioning in CD have so far been underpowered for investigating sex differences. Therefore, our primary aim was to characterize emotion processing skills in a large sample of girls and boys with CD compared to typically developing controls (TDCs) using a comprehensive neuropsychological test battery.

METHOD

We included 542 youths with CD (317 girls) and 710 TDCs (479 girls), 9 to 18 years of age, from a European multisite study (FemNAT-CD). Participants completed three experimental tasks assessing emotion recognition, learning, and regulation, respectively. Data were analyzed to test for effects of group and sex, and group-by-sex interactions, while controlling for potentially confounding factors.

RESULTS

Relative to TDCs, youths with CD showed impaired emotion recognition (that was related to more physical and proactive aggression, and higher CU traits), emotional learning (specifically from punishment), and emotion regulation. Boys and girls with CD, however, displayed similar impairments in emotion processing.

CONCLUSION

This study provides compelling evidence for a relationship between CD and deficient neurocognitive functioning across three emotional domains that have previously been linked to CD etiology. However, there was no support for sex-specific profiles of emotion dysfunction, suggesting that current neurocognitive models of CD apply equally to both sexes.

Modulation of cognitive flexibility by reward and punishment in BALB/cJ and BALB/cByJ mice

Learning from feedback is one of the key mechanisms within cognitive flexibility, which is needed to react swiftly to constantly changing environments. The motivation to change behavior is highly dependent on the expectancy of positive (reward) or negative (punishment) feedback. Individuals with conduct disorder (CD) with high callous unemotional traits show decreased sensitivity to negative feedback and increased reward seeking. Previous studies have modeled traits associated with CD (i.e. heightened aggression and anti-social behavior) in BALB/cJ mice (compared to the BALB/cByJ mouse as controls). Based on these findings, we hypothesized reduced negative feedback-related cognitive flexibility to be present in BALB/cJ mice. The effect of negative feedback and reward sensitivity on cognitive flexibility in BALB/cJ and BALB/cByJ mice was examined in a reversal learning paradigm. BALB/cJ mice were more flexible in the acquisition of new contingencies under rewarding conditions compared to BALB/cByJ mice, while the presence of an aversive punishing stimulus decreased their learning performance. Additionally, BALB/cJ mice needed more correction trials to reach the reversal learning criterion. This was accompanied by a higher rate of perseverance, which could represent impaired error detection. The addition of a second punishment enhanced punishment sensitivity in BALB/cJ mice. In contrast, the performance of the BALB/cByJ mice was not affected by additional negative feedback. Taken together, the BALB/cJ can be considered to be less sensitive to learn from negative feedback and therefore may be a useful model to further characterize molecular and neural underpinnings of callous unemotional traits in CD.

The Impact of Callous-Unemotional Traits and Externalizing Tendencies on Neural Responsivity to Reward and Punishment in Healthy Adolescents

Both externalizing behavior and callous-unemotional (CU) traits in youth are precursors to later criminal offending in adulthood. It is posited that disruptions in reward and punishment processes may engender problematic behavior, such that CU traits and externalizing behavior may be linked to a dominant reward response style (e.g., heightened responsivity to rewards) and deficient punishment-processing. However, prior research has generated mixed findings and work examining both the sole and joint contribution of CU traits and externalizing problems related to functional brain alterations is lacking. In this pilot functional magnetic resonance imaging study, we measured externalizing behavior and CU traits in a community sample of adolescents (n = 29) and examined their impacts on brain activity associated with anticipation and receipt of reward and punishment using the Modified Monetary Incentive Delay task. We found that CU traits were associated with greater activation of the ventral striatum (VST) during reward anticipation. However, this effect became non-significant after controlling for externalizing behavior, indicating substantial overlap between the CU and externalizing measures in explaining VST activation when anticipating reward. In addition, externalizing behavior (but not CU) was significantly negatively associated with amygdala activation during punishment receipt, even after controlling for CU traits. The present findings extend previous evidence of hyper-responsivity to reward and hypo-responsivity to punishment in relation to psychopathic traits and antisocial behavior to non-clinical, non-incarcerated youths.

A Pilot Study of Emotional Response to Time-Out in Children With Conduct Problems and Callous-Unemotional Traits

Little research has examined how children with conduct problems and concurrent callous-unemotional traits (CPCU) emotionally and behaviorally respond to time-out. This pilot study examined the distribution and stability of emotions during time-out as well as the association between emotions and negative behaviors. Participants were 11 children (M_age = 9.8 years) with CPCU who participated in a summer treatment program designed specifically for children with CPCU. Summer treatment program counselors rated each child's emotion when time-out was first assigned and then as the time-out progressed and indicated whether the child had negative behavior during time-out. These ratings were completed for approximately 30% of time-outs that occurred. Results showed that children were mostly rated as "unemotional" or "calm" and that these emotions were relatively stable throughout time-out. Furthermore, negative behaviors were most common during time-outs when children's emotions were rated as "amused." Results provide groundwork for future research to extend upon the methods used in the current study to further examine the emotional and behavioral response to time-out in children with CPCU.

The Sensitivity to Threat and Affiliative Reward (STAR) model and the development of callous-unemotional traits

Research implicates callous-unemotional (CU) traits (i.e., lack of empathy, prosociality, and guilt, and reduced sensitivity to others' emotions) in the development of severe and persistent antisocial behavior. To improve etiological models of antisocial behavior and develop more effective treatments, we need a better understanding of the origins of CU traits. In this review, we discuss the role of two psychobiological and mechanistic precursors to CU traits: low affiliative reward (i.e., deficits in seeking out or getting pleasure from social bonding and closeness with others) and low threat sensitivity (i.e., fearlessness to social and non-social threat). We outline the Sensitivity to Threat and Affiliative Reward (STAR) model and review studies that have examined the development of affiliative reward and threat sensitivity across animal, neuroimaging, genetic, and behavioral perspectives. We next evaluate evidence for the STAR model, specifically the claim that CU traits result from deficits in both affiliative reward and threat sensitivity. We end with constructive suggestions for future research to test the hypotheses generated by the STAR model.

Indirect Effects of Early Parenting on Adult Antisocial Outcomes via Adolescent Conduct Disorder Symptoms and Callous-Unemotional Traits

Parental harsh punishment and warmth have been associated with child and adolescent conduct disorder (CD) symptoms and callous-unemotional (CU) traits (i.e., lack of guilt, empathy, and deficient affect); however, it is unclear whether the effect of these parenting behaviors on antisocial outcomes persists into adulthood. Thus, the present study aimed to test whether adolescent CD symptoms and CU traits mediate the effect of parental harsh punishment and warmth on adult antisocial outcomes (i.e., antisocial personality disorder (ASPD), externalizing psychopathology, partner violence, and violent and substance crime). Participants included the high-risk control and normative samples from the Fast Track project (N =753, male = 58%, African American = 46%). Harsh punishment during kindergarten through grades 1-2 predicted higher adolescent CD symptoms, and directly observed warmth during kindergarten through grades 1-2 predicted lower adolescent CU traits. Adolescent CD symptoms predicted greater adult substance crime, and adolescent CU traits predicted greater adult ASPD symptoms and externalizing psychopathology. Further, adolescent CD symptoms indirectly accounted for the effect of parental harsh punishment on adult substance crime, and adolescent CU traits indirectly accounted for the effect of parental warmth on ASPD symptoms and externalizing psychopathology. Findings support the importance of early interventions targeting parenting behaviors to reduce risk for the development of antisocial behavior, and inform developmental models of antisocial behavior in adolescence through adulthood.

The structural brain correlates of callous-unemotional traits in incarcerated male adolescents

Youth with severe conduct problems impose a significant cost on society by engaging in high levels of antisocial and aggressive behavior. Within this group, adolescents with high levels of callous- unemotional traits have been found to exhibit more severe and persistent patterns of antisocial behavior than youth with severe conduct problems but normative levels of callous-unemotional traits. Existing neuroimaging studies, along with theoretical accounts of psychopathology, suggest that dysfunction within the paralimbic cortex and limbic system may underlie elevated levels of callous-unemotional traits. The present study examines this hypothesis by investigating gray matter correlates associated with callous-unemotional traits. A sample of incarcerated male adolescents (N = 269), were assessed using voxel-based morphometry. Callous-unemotional traits were assessed using the Inventory of Callous-Unemotional traits (Frick 2004). Total callous-unemotional traits were negatively correlated with anterior temporal lobe gray matter volume (GMV). Callous traits in particular exhibited a reliable negative correlation with gray matter volume in nearly every paralimbic brain region examined. Uncaring traits were positively correlated with GMV in the orbitofrontal and anterior cingulate cortices. These findings demonstrate specific neural features within the paralimbic cortex and limbic system that accompany elevated callous-unemotional traits and serves to expand our understanding of pathophysiological mechanisms that may give rise to severe conduct problems in youth.

•

Total callous-unemotional traits were negatively correlated with anterior temporal lobe gray matter volume (GMV).

•

Callous traits negatively correlated with GMV in nearly every paralimbic regions examined.

•

Uncaring traits were positively correlated with GMV in the orbitofrontal and anterior cingulate cortices.