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O’Leary A, Lahey T, Lovato J, Loftness B, Douglas A, Skelton J, Cohen JG, Copeland WE, McGinnis RS, McGinnis EW. Using Wearable Digital Devices to Screen Children for Mental Health Conditions: Ethical Promises and Challenges. SENSORS (BASEL, SWITZERLAND) 2024; 24:3214. [PMID: 38794067 PMCID: PMC11125700 DOI: 10.3390/s24103214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/13/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024]
Abstract
In response to a burgeoning pediatric mental health epidemic, recent guidelines have instructed pediatricians to regularly screen their patients for mental health disorders with consistency and standardization. Yet, gold-standard screening surveys to evaluate mental health problems in children typically rely solely on reports given by caregivers, who tend to unintentionally under-report, and in some cases over-report, child symptomology. Digital phenotype screening tools (DPSTs), currently being developed in research settings, may help overcome reporting bias by providing objective measures of physiology and behavior to supplement child mental health screening. Prior to their implementation in pediatric practice, however, the ethical dimensions of DPSTs should be explored. Herein, we consider some promises and challenges of DPSTs under three broad categories: accuracy and bias, privacy, and accessibility and implementation. We find that DPSTs have demonstrated accuracy, may eliminate concerns regarding under- and over-reporting, and may be more accessible than gold-standard surveys. However, we also find that if DPSTs are not responsibly developed and deployed, they may be biased, raise privacy concerns, and be cost-prohibitive. To counteract these potential shortcomings, we identify ways to support the responsible and ethical development of DPSTs for clinical practice to improve mental health screening in children.
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Affiliation(s)
- Aisling O’Leary
- Department of Philosophy, Virginia Polytechnic Institute and State University, Blacksburg, VA 24060, USA;
| | - Timothy Lahey
- University of Vermont Medical Center, Burlington, VT 05401, USA; (T.L.); (A.D.)
| | - Juniper Lovato
- Complex Systems Center, University of Vermont, Burlington VT 05405, USA; (J.L.); (B.L.)
| | - Bryn Loftness
- Complex Systems Center, University of Vermont, Burlington VT 05405, USA; (J.L.); (B.L.)
| | - Antranig Douglas
- University of Vermont Medical Center, Burlington, VT 05401, USA; (T.L.); (A.D.)
| | - Joseph Skelton
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem 27101, NC, USA;
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem 27101, NC, USA
| | - Jenna G. Cohen
- Department of Electrical and Biomedical Engineering, University of Vermont, Burlington VT 05405, USA;
| | | | - Ryan S. McGinnis
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem 27101, NC, USA
| | - Ellen W. McGinnis
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem 27101, NC, USA;
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem 27101, NC, USA
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Maurer JM, Anderson NE, Allen CH, Kiehl KA. Examining the Association between Psychopathic Traits and Fearlessness among Maximum-Security Incarcerated Male Adolescents. CHILDREN (BASEL, SWITZERLAND) 2024; 11:65. [PMID: 38255377 PMCID: PMC10814550 DOI: 10.3390/children11010065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/14/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Abstract
Studies have reported positive associations between youth psychopathy scores and measures of 'fearlessness'. However, prior studies modified fearlessness items to be age appropriate, shifting from assessing hypothetical, extreme forms of physical risk-taking (e.g., flying an airplane) to normative risk-taking (e.g., riding bicycles downhill). We hypothesize that associations between youth psychopathy scores and alternative forms of sensation seeking (i.e., Disinhibition) have been conflated under a false fearlessness label. We tested this hypothesis among incarcerated male adolescents, investigating whether youth psychopathy scores were significantly associated with two different forms of sensation seeking: Disinhibition and Thrill and Adventure Seeking (TAS). Youth psychopathic traits were assessed using the Psychopathy Checklist: Youth Version (PCL:YV), Antisocial Process Screening Device (APSD), Child Psychopathy Scale (CPS), Inventory of Callous and Unemotional Traits (ICU), and Youth Psychopathic Traits Inventory (YPI). Disinhibition and fearlessness (i.e., TAS) were assessed using an unmodified version of the Zuckerman Sensation Seeking Scales (SSS). Consistent with hypotheses, youth psychopathy scores were associated with higher Disinhibition and lower TAS scores. Our results contribute to a growing body of literature suggesting that psychopathic traits, including among adolescents, are not concomitant with physical risk-taking and descriptions of psychopathy including fearlessness distort a precise understanding of psychopathy's core features.
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Affiliation(s)
- J. Michael Maurer
- The Mind Research Network, 1101 Yale Boulevard NE, Albuquerque, NM 87106, USA; (J.M.M.)
| | - Nathaniel E. Anderson
- The Mind Research Network, 1101 Yale Boulevard NE, Albuquerque, NM 87106, USA; (J.M.M.)
| | - Corey H. Allen
- The Mind Research Network, 1101 Yale Boulevard NE, Albuquerque, NM 87106, USA; (J.M.M.)
| | - Kent A. Kiehl
- The Mind Research Network, 1101 Yale Boulevard NE, Albuquerque, NM 87106, USA; (J.M.M.)
- Departments of Psychology, Neuroscience and Law, University of New Mexico, Albuquerque, NM 87106, USA
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Wagner N, Perkins E, Rodriguez Y, Ordway C, Flum M, Hernandez-Pena L, Perelstein P, Sem K, Paz Y, Plate R, Popoola A, Lynch S, Astone K, Goldstein E, Njoroge WFM, Raine A, Pincus D, Pérez-Edgar K, Waller R. Promoting Empathy and Affiliation in Relationships (PEAR) study: protocol for a longitudinal study investigating the development of early childhood callous-unemotional traits. BMJ Open 2023; 13:e072742. [PMID: 37802613 PMCID: PMC10565261 DOI: 10.1136/bmjopen-2023-072742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 09/15/2023] [Indexed: 10/10/2023] Open
Abstract
INTRODUCTION Children with callous-unemotional (CU) traits are at high lifetime risk of antisocial behaviour. Low affiliation (ie, social bonding difficulties) and fearlessness (ie, low threat sensitivity) are proposed risk factors for CU traits. Parenting practices (eg, harshness and low warmth) also predict risk for CU traits. However, few studies in early childhood have identified attentional or physiological markers of low affiliation and fearlessness. Moreover, no studies have tested whether parenting practices are underpinned by low affiliation or fearlessness shared by parents, which could further shape parent-child interactions and exacerbate risk for CU traits. Addressing these questions will inform knowledge of how CU traits develop and isolate novel parent and child targets for future specialised treatments for CU traits. METHODS AND ANALYSIS The Promoting Empathy and Affiliation in Relationships (PEAR) study aims to establish risk factors for CU traits in children aged 3-6 years. The PEAR study will recruit 500 parent-child dyads from two metropolitan areas of the USA. Parents and children will complete questionnaires, computer tasks and observational assessments, alongside collection of eye-tracking and physiological data, when children are aged 3-4 (time 1) and 5-6 (time 2) years. The moderating roles of child sex, race and ethnicity, family and neighbourhood disadvantage, and parental psychopathology will also be assessed. Study aims will be addressed using structural equation modelling, which will allow for flexible characterisation of low affiliation, fearlessness and parenting practices as risk factors for CU traits across multiple domains. ETHICS AND DISSEMINATION Ethical approval was granted by Boston University (#6158E) and the University of Pennsylvania (#850638). Results will be disseminated through conferences and open-access publications. All study and task materials will be made freely available on lab websites and through the Open Science Framework (OSF).
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Affiliation(s)
- Nicholas Wagner
- Department of Brain & Psychological Science, Boston University, Boston, Massachusetts, USA
| | - Emily Perkins
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yuheiry Rodriguez
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cora Ordway
- Department of Brain & Psychological Science, Boston University, Boston, Massachusetts, USA
| | - Michaela Flum
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lucia Hernandez-Pena
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Polina Perelstein
- Department of Brain & Psychological Science, Boston University, Boston, Massachusetts, USA
| | - Kathy Sem
- Department of Brain & Psychological Science, Boston University, Boston, Massachusetts, USA
| | - Yael Paz
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rista Plate
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ayomide Popoola
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sarah Lynch
- Department of Brain & Psychological Science, Boston University, Boston, Massachusetts, USA
| | - Kristina Astone
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Ethan Goldstein
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Wanjikũ F M Njoroge
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Adriane Raine
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Donna Pincus
- Department of Brain & Psychological Science, Boston University, Boston, Massachusetts, USA
| | | | - Rebecca Waller
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Fanti KA, Mavrommatis I, Colins O, Andershed H. Fearlessness as an Underlying Mechanism Leading to Conduct Problems: Testing the Intermediate Effects of Parenting, Anxiety, and callous-unemotional Traits. Res Child Adolesc Psychopathol 2023:10.1007/s10802-023-01076-7. [PMID: 37191864 DOI: 10.1007/s10802-023-01076-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2023] [Indexed: 05/17/2023]
Abstract
This study investigates whether the longitudinal association between fearlessness and conduct problems (CP) is mediated by warm and harsh parenting, parent-child conflict, anxiety, and callous-unemotional (CU) traits. The constructs under investigation were assessed at five different time points, spanning a period of eight years. A multi-informant approach was followed, collecting data from parents and teachers (N = 2,121; 47% girls). The structural equation model pointed to both direct and indirect pathways between fearlessness and CP. Specifically, findings suggested that Time 1 fearlessness (age 3-5 years) increased the likelihood of Time 2 (age 4-6 years) harsh parenting and Time 3 (age 5-7 years) parent-child conflict. Further, fearlessness was positively associated with Time 4 (age 8-10) callous-unemotional traits and Time 5 (age 11-13) CP. The total indirect effect from fearlessness to CP through these variables was significant, although the specific indirect effect from fearlessness to CU traits to CP accounted for most of the variance. Warm parenting and anxiety did not mediate the association between fearlessness and CP. In addition to the identified pathways connecting fearlessness to CP, findings pointed to the existence of multiple developmental pathways to future CP, as well as gender differences in longitudinal associations.
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Affiliation(s)
- Kostas A Fanti
- Department of Psychology, University of Cyprus, P.O. Box 20537, Nicosia, CY, 1678, Cyprus.
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