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Muratori P, Palumbo S, Vellucci S, Mariotti V, Billeci L, Levantini V, Inguaggiato E, Masi G, Milone A, Pellegrini S. Deficits in emotion recognition and processing in children with high callous-unemotional traits: the role of the MAOA gene. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02397-8. [PMID: 38507052 DOI: 10.1007/s00787-024-02397-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 02/13/2024] [Indexed: 03/22/2024]
Abstract
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.
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Affiliation(s)
- Pietro Muratori
- Scientific Institute of Child Neurology and Psychiatry, IRCCS Fondazione Stella Maris, Calambrone, Pisa, Italy
| | - Sara Palumbo
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | - Stefano Vellucci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Veronica Mariotti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lucia Billeci
- Institute of Clinical Physiology, National Research Council of Italy (CNR), Pisa, Italy
| | - Valentina Levantini
- Scientific Institute of Child Neurology and Psychiatry, IRCCS Fondazione Stella Maris, Calambrone, Pisa, Italy
| | - Emanuela Inguaggiato
- Scientific Institute of Child Neurology and Psychiatry, IRCCS Fondazione Stella Maris, Calambrone, Pisa, Italy
| | - Gabriele Masi
- Scientific Institute of Child Neurology and Psychiatry, IRCCS Fondazione Stella Maris, Calambrone, Pisa, Italy
| | - Annarita Milone
- Scientific Institute of Child Neurology and Psychiatry, IRCCS Fondazione Stella Maris, Calambrone, Pisa, Italy
| | - Silvia Pellegrini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Díaz-Vázquez B, López-Romero L, Romero E. Emotion Recognition Deficits in Children and Adolescents with Psychopathic Traits: A Systematic Review. Clin Child Fam Psychol Rev 2024; 27:165-219. [PMID: 38240937 PMCID: PMC10920463 DOI: 10.1007/s10567-023-00466-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2023] [Indexed: 03/08/2024]
Abstract
Children and adolescents with psychopathic traits show deficits in emotion recognition, but there is no consensus as to the extent of their generalizability or about the variables that may be moderating the process. The present Systematic Review brings together the existing scientific corpus on the subject and attempts to answer these questions through an exhaustive review of the existing literature according to PRISMA 2020 statement. Results confirmed the existence of pervasive deficits in emotion recognition and, more specifically, on distress emotions (e.g., fear), a deficit that transcends all modalities of emotion presentation and all emotional stimuli used. Moreover, they supported the key role of attention to relevant areas that provide emotional cues (e.g., eye-region) and point out differences according to the presence of disruptive behavior and based on the psychopathy dimension examined. This evidence could advance the current knowledge on developmental models of psychopathic traits. Yet, homogenization of the conditions of research in this area should be prioritized to be able to draw more robust and generalizable conclusions.
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Affiliation(s)
- Beatriz Díaz-Vázquez
- Department of Clinical Psychology and Psychobiology, Facultade de Psicoloxía, Universidade de Santiago de Compostela, Campus Vida, Santiago de Compostela, Spain
| | - Laura López-Romero
- Department of Clinical Psychology and Psychobiology, Facultade de Psicoloxía, Universidade de Santiago de Compostela, Campus Vida, Santiago de Compostela, Spain.
| | - Estrella Romero
- Department of Clinical Psychology and Psychobiology, Facultade de Psicoloxía, Universidade de Santiago de Compostela, Campus Vida, Santiago de Compostela, Spain
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Levantini V, Muratori P, Bertacchi I, Grilli V, Marzano A, Masi G, Milone A, Kimonis ER. The "Measure of Empathy in Early Childhood": Psychometric Properties and Associations with Externalizing Problems and Callous Unemotional Traits. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01673-7. [PMID: 38261151 DOI: 10.1007/s10578-024-01673-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/14/2024] [Indexed: 01/24/2024]
Abstract
Empathy is crucial to the development of socio-emotional skills in youth and empathy development is central to understanding and subtyping youth with externalizing problems. This study explored for the first time the psychometric properties of the Measure of Empathy in Early Childhood (MEEC) in a sample of 652 Italian children aged 6 to 8 years. The gender invariance of MEEC scores and their associations with other measures of empathy and prosocial behavior, and children's externalizing problems and callous-unemotional (CU) traits were also evaluated. Results indicated that with some modifications, a 5-factor structure of the Italian version of MEEC scores fitted the data and was invariant across gender. Results further supported the reliability and validity of MEEC total and subscale scores. Practical implications of these results are discussed.
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Affiliation(s)
- Valentina Levantini
- Scientific Institute of Child Neurology and Psychiatry, IRCCS Stella Maris, Pisa, Italy
| | - Pietro Muratori
- Scientific Institute of Child Neurology and Psychiatry, IRCCS Stella Maris, Pisa, Italy.
| | - Iacopo Bertacchi
- Accademia di Neuropsicologia dello Sviluppo (A.N.Svi), Reggio Emilia, Italy
| | - Virginia Grilli
- Scientific Institute of Child Neurology and Psychiatry, IRCCS Stella Maris, Pisa, Italy
| | | | - Gabriele Masi
- Scientific Institute of Child Neurology and Psychiatry, IRCCS Stella Maris, Pisa, Italy
| | - Annarita Milone
- Scientific Institute of Child Neurology and Psychiatry, IRCCS Stella Maris, Pisa, Italy
| | - Eva R Kimonis
- Parent-Child Research Clinic, School of Psychology, University of New South Wales, Sydney, Australia
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Masi G, Carucci S, Muratori P, Balia C, Sesso G, Milone A. Contemporary diagnosis and treatment of conduct disorder in youth. Expert Rev Neurother 2023; 23:1277-1296. [PMID: 37853718 DOI: 10.1080/14737175.2023.2271169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/04/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Conduct disorder (CD) is characterized by repetitive and persistent antisocial behaviors, being among the most frequently reported reasons of referral in youth. CD is a highly heterogeneous disorder, with possible specifiers defined according to age at onset, Limited Prosocial Emotions (LPE) otherwise known as Callous-Unemotional (CU) traits, Emotional Dysregulation (ED), and patterns of comorbidity, each with its own specific developmental trajectories. AREAS COVERED The authors review the evidence from published literature on the clinical presentations, diagnostic procedures, psychotherapeutic and psychoeducational approaches, and pharmacological interventions from RCT and naturalistic studies in youth. Evidence from studies including youths with LPE/CU traits, ED and aggression are also reviewed, as response moderators. EXPERT OPINION Due to its clinical heterogeneity, relevant subtypes of CD should be carefully characterized to gain reliable information on prognosis and treatments. Thus, disentangling this broad category in subtypes is crucial as a first step in diagnosis. Psychosocial interventions are the first option, possibly improving LPE/CU traits and ED, especially if implemented early during development. Instead, limited information, based on low-quality studies, supports pharmacological options. Second-generation antipsychotics, mood stabilizers, and stimulants are first-line medications, according to different target symptoms, such as aggression and emotional reactivity. Developmental pathways including ADHD suggest a specific role of psychostimulants.
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Affiliation(s)
- Gabriele Masi
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Pisa, Italy
| | - Sara Carucci
- Department of Biomedical Science, Section of Neuroscience & Clinical Pharmacology, University of Cagliari, Cagliari, Italy
- Child & Adolescent Neuropsychiatric Unit, "A. Cao" Paediatric Hospital-ARNAS "G. Brotzu" Hospital Trust, Department of Paediatrics, Cagliari, Italy
| | - Pietro Muratori
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Pisa, Italy
| | - Carla Balia
- Department of Biomedical Science, Section of Neuroscience & Clinical Pharmacology, University of Cagliari, Cagliari, Italy
- Child & Adolescent Neuropsychiatric Unit, "A. Cao" Paediatric Hospital-ARNAS "G. Brotzu" Hospital Trust, Department of Paediatrics, Cagliari, Italy
| | - Gianluca Sesso
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Pisa, Italy
- Social and Affective Neuroscience Group, Molecular Mind Lab, IMT School for Advanced Studies Lucca, Lucca, Italy
| | - Annarita Milone
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Pisa, Italy
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Sesso G, Masi G. Pharmacological strategies for the management of the antisocial personality disorder. Expert Rev Clin Pharmacol 2023; 16:181-194. [PMID: 36787887 DOI: 10.1080/17512433.2023.2181159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/09/2023] [Indexed: 02/16/2023]
Abstract
INTRODUCTION Antisocial personality disorder (AsPD) is a pervasive pattern of violation of others' rights, related to the concept of psychopathy. AsPD is stable over time from adolescence, with evidence of conduct disorder (CD) before 15 years. DSM-5 included a specifier 'with limited prosocial emotions' (LPE), which characterizes adolescents with higher developmental vulnerability to develop AsPD. Despite being relatively frequent with considerable societal impact, AsPD is a difficult-to-treat condition with high comorbidity rates and poor evidence for effective pharmacological interventions. AREAS COVERED We conducted a narrative review and searched PubMed up to September 2022. We included RCTs and naturalistic studies evaluating pharmacological interventions on AsPD in adults, including those with comorbid substance use disorder or psychopathic traits. Evidence in youths with CD, callous-unemotional (CU) traits and aggression were also reviewed, exploring the role of CU traits as moderators of response. EXPERT OPINION Psychosocial interventions are the first option, with possible improvement of CU traits, beyond behavioral and affective symptoms, particularly if implemented early during development. Limited information, based on low-quality studies, supports the pharmacological options. Second-generation antipsychotics, lithium, anti-epileptic drugs, and stimulants are first-line medications, according to different target symptoms. Developmental pathways including ADHD suggest a specific role of psychostimulants.
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Affiliation(s)
- Gianluca Sesso
- Social and Affective Neuroscience Group, Molecular Mind Lab, IMT School for Advanced Studies Lucca, Lucca, Italy
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Pisa, Italy
| | - Gabriele Masi
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Pisa, Italy
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Fantozzi P, Muratori P, Levantini V, Mammarella I, Masi G, Milone A, Petrucci A, Ricci F, Tacchi A, Cristofani C, Valente E. Callous-Unemotional Traits and Intelligence in Children with Externalizing Behavioral Problems. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1768. [PMID: 36421217 PMCID: PMC9689262 DOI: 10.3390/children9111768] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/02/2022] [Accepted: 11/15/2022] [Indexed: 11/15/2023]
Abstract
Research on the association between callous-unemotional (CU) traits and intelligence yielded contradictory results. Moreover, several previous studies focused on global intelligence scores or verbal vs. nonverbal/performance abilities usually evaluated with short/abbreviated instruments. The current study builds on these previous works and explores the link between CU traits and intelligence using the full version of the Wechsler Intelligence Scale for Children-4th Edition (WISC-IV), which provides four different verbal and nonverbal abilities scores. This guarantees a more detailed evaluation of children's intelligence and its relation to CU traits. The sample included children (N = 149; age 6-14 years old) with severe behavioral problems. Clinicians administered the WISC-IV, and parents completed questionnaires evaluating the child's externalizing problems and CU traits. Findings showed that CU traits were associated with lower verbal comprehension scores after also controlling for gender, age, externalizing problems, and the other WISC-IV indexes. In addition, CU traits and externalizing problems did not interact in predicting the WISC-IV indexes, and there were no significant differences in the WISC-IV indexes between children with CU traits and high vs. low externalizing problems. The current study suggests the relevance of assessing and addressing verbal abilities in children with behavioral problems and CU traits.
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Affiliation(s)
| | | | - Valentina Levantini
- Department of Languages and Literatures, Communication, Education and Society, University of Udine, 33100 Udine, Italy
| | - Irene Mammarella
- Department of Developmental and Social Psychology, University of Padova, 35122 Padua, Italy
| | | | | | - Alessia Petrucci
- Department of Developmental and Social Psychology, University of Padova, 35122 Padua, Italy
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Hachtel H, Jenkel N, Schmeck K, Graf M, Fegert JM, Schmid M, Boonmann C. Stability of self-reported psychopathic traits in at-risk adolescents in youth welfare and juvenile justice institutions. Child Adolesc Psychiatry Ment Health 2022; 16:55. [PMID: 35765005 PMCID: PMC9241249 DOI: 10.1186/s13034-022-00487-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the self-reported stability of psychopathic traits in adolescents in residential care (both child welfare and juvenile justice placed juveniles) and potential influencing factors. METHODS We applied the Youth Psychopathic traits Inventory (YPI) in a sample of 162 adolescents (M = 15.0 years, SD = 1.3) over a mean time interval of 11 months (min. 6, max. 21 months, SD = 3.14). RESULTS There was no significant difference in YPI total score nor in the three underlying dimensions Grandiose-Manipulative (GM), Callous-Unemotional (CU), and Impulsive-Irresponsible (II) between t1 and t2. Furthermore, approximately 70% of the adolescents showed no clinically significant reliable change on the YPI total score (as measured with the reliable change index), 15% improved, 15% deteriorated. The strongest predictor for psychopathic traits at t2 were psychopathic traits at t1. Additional predictors for higher levels of general psychopathic traits was male sex, for CU-traits male sex and lower levels of internalizing mental health problems, and for II-traits higher levels of externalizing mental health problems. Generally, the three reliable change groups (increase, no change, decrease) did not seemed to differ on relevant factors. CONCLUSIONS Our results add to the findings that psychopathic traits are relatively stable in this at-risk group over approximately a 1-year time interval. Research with a longer follow-up time and more time points is warranted to better interpret these results.
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Affiliation(s)
- H. Hachtel
- grid.412556.10000 0004 0479 0775Department of Forensic Psychiatry, Psychiatric University Hospitals (UPK) Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland
| | - N. Jenkel
- grid.412556.10000 0004 0479 0775Child and Adolescent Research Department, Psychiatric University Hospitals (UPK) Basel, Basel, Switzerland
| | - K. Schmeck
- grid.412556.10000 0004 0479 0775Child and Adolescent Research Department, Psychiatric University Hospitals (UPK) Basel, Basel, Switzerland
| | - M. Graf
- grid.412556.10000 0004 0479 0775Department of Forensic Psychiatry, Psychiatric University Hospitals (UPK) Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland
| | - J. M. Fegert
- grid.410712.10000 0004 0473 882XDepartment of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Ulm, Ulm, Germany
| | - M. Schmid
- grid.412556.10000 0004 0479 0775Child and Adolescent Research Department, Psychiatric University Hospitals (UPK) Basel, Basel, Switzerland
| | - C. Boonmann
- grid.412556.10000 0004 0479 0775Department of Forensic Psychiatry, Psychiatric University Hospitals (UPK) Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland ,grid.412556.10000 0004 0479 0775Child and Adolescent Research Department, Psychiatric University Hospitals (UPK) Basel, Basel, Switzerland ,grid.6612.30000 0004 1937 0642Department of Psychology, University of Basel, Basel, Switzerland
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