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Yirmiya K, Constantinou M, Simes E, Bateman A, Wason J, Yakeley J, McMurran M, Crawford M, Frater A, Moran P, Barrett B, Cameron A, Hoare Z, Allison E, Pilling S, Butler S, Fonagy P. The mediating role of reflective functioning and general psychopathology in the relationship between childhood conduct disorder and adult aggression among offenders. Psychol Med 2024:1-12. [PMID: 38563288 DOI: 10.1017/s003329172400062x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND The nature of the pathway from conduct disorder (CD) in adolescence to antisocial behavior in adulthood has been debated and the role of certain mediators remains unclear. One perspective is that CD forms part of a general psychopathology dimension, playing a central role in the developmental trajectory. Impairment in reflective functioning (RF), i.e., the capacity to understand one's own and others' mental states, may relate to CD, psychopathology, and aggression. Here, we characterized the structure of psychopathology in adult male-offenders and its role, along with RF, in mediating the relationship between CD in their adolescence and current aggression. METHODS A secondary analysis of pre-treatment data from 313 probation-supervised offenders was conducted, and measures of CD symptoms, general and specific psychopathology factors, RF, and aggression were evaluated through clinical interviews and questionnaires. RESULTS Confirmatory factor analyses indicated that a bifactor model best fitted the sample's psychopathology structure, including a general psychopathology factor (p factor) and five specific factors: internalizing, disinhibition, detachment, antagonism, and psychoticism. The structure of RF was fitted to the data using a one-factor model. According to our mediation model, CD significantly predicted the p factor, which was positively linked to RF impairments, resulting in increased aggression. CONCLUSIONS These findings highlight the critical role of a transdiagnostic approach provided by RF and general psychopathology in explaining the link between CD and aggression. Furthermore, they underscore the potential utility of treatments focusing on RF, such as mentalization-based treatment, in mitigating aggression in offenders with diverse psychopathologies.
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Affiliation(s)
- Karen Yirmiya
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Anna Freud National Centre for Children and Families, London, UK
| | - Matthew Constantinou
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Anna Freud National Centre for Children and Families, London, UK
| | - Elizabeth Simes
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Anna Freud National Centre for Children and Families, London, UK
| | - Anthony Bateman
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Anna Freud National Centre for Children and Families, London, UK
| | - James Wason
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jessica Yakeley
- Portman Clinic, Tavistock and Portman NHS Foundation Trust, London, UK
| | - Mary McMurran
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Mike Crawford
- Division of Psychiatry, Imperial College, London, UK
| | - Alison Frater
- School of Law, Royal Holloway, University of London, London, UK
| | - Paul Moran
- Centre for Academic Mental Health, Population Health Sciences Department, Bristol Medical School, University of Bristol, Bristol, UK
| | - Barbara Barrett
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Angus Cameron
- National Probation Service London Division, London, UK
| | - Zoe Hoare
- NWORTH Clinical Trials Unit, School of Health Sciences, Bangor University, Bangor, UK
| | - Elizabeth Allison
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Anna Freud National Centre for Children and Families, London, UK
| | - Stephen Pilling
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Stephen Butler
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Anna Freud National Centre for Children and Families, London, UK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Anna Freud National Centre for Children and Families, London, UK
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Fonagy P, Luyten P, Allison E, Campbell C. Taking stock to move forward: Where the field of developmental psychopathology might be heading. Dev Psychopathol 2024:1-10. [PMID: 38389294 DOI: 10.1017/s0954579424000312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
In this paper, dedicated to Dante Cicchetti's contributions and enduring influence, we explore the prospective directions of developmental psychopathology. Our focus centers on key domains where Cicchetti's significant achievements have continually shaped our evolving thinking about psychological development. These domains include (a) the concepts of equifinality and multifinality, along with the challenges in predicting developmental trajectories, (b) the imperative to integrate wider sociocultural viewpoints into developmental psychopathology frameworks, (c) the interplay of genetic and environmental influences in developmental courses, (d) the significance of mental state language, and (e) the progress, or its absence, in the development of prevention and intervention tactics for children, adolescents, and their caregivers. While many of our forecasts regarding the future of developmental psychopathology may not materialize, we maintain optimistic that the essential ideas presented will influence the research agenda in this field and contribute to its growth over the next fifty years.
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Affiliation(s)
- Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Patrick Luyten
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Elizabeth Allison
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Chloe Campbell
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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3
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Flaaten E, Langfeldt M, Morken KTE. Antisocial personality disorder and therapeutic pessimism - how can mentalization-based treatment contribute to an increased therapeutic optimism among health professionals? Front Psychol 2024; 15:1320405. [PMID: 38449745 PMCID: PMC10915228 DOI: 10.3389/fpsyg.2024.1320405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/06/2024] [Indexed: 03/08/2024] Open
Abstract
Antisocial personality disorder (ASPD) is associated with therapeutic pessimism among health professionals. Several variables are associated with obstacles in therapist's willingness to treat ASPD. Variables that are relevant are (i) confusion associated with the term ASPD, (ii) characteristics of the disorder, (iii) attitudes, experiences, and knowledge clinicians possess, and (iv) insufficient management of countertransference. We assume that therapeutic pessimism is related to the lack of evidence-based, effective treatment for individuals with ASPD. This is problematic because ASPD is associated with large socio-economic costs and considerable suffering for the individual and the society. Mentalization-based treatment (MBT) was developed in treating borderline personality disorder (BPD) and is now considered an effective treatment for this group. Mentalization is defined as the process by which individuals make sense of themselves and others in terms of subjective states and mental processes. This ability affects an individual's psychological functioning, mental health, self-organization, and interpersonal relationships. The overall goal of MBT is to strengthen the individual's mentalizing abilities and facilitate more adaptive handling of problematic, internal states. Recently, a version of MBT tailored for individuals with ASPD (MBT-ASPD) has been developed. The purpose of this review is to investigate how MBT-ASPD relates to the major obstacles that contribute to the therapeutic pessimism toward this group. Despite a limited evidence base, preliminary studies indicate promising results for MBT-ASPD. More research is still required, this review suggests MBT-ASPD can contribute to increased therapeutic optimism and demonstrate specific characteristics of MBT-ASPD that contribute to management of therapeutic pessimism.
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Affiliation(s)
- Emilie Flaaten
- Drammen Hospital, Outpatient Team for Addiction and Mental Health, Vestre Viken Hospital Trust, Drammen, Norway
| | - Maria Langfeldt
- Blakstad Hospital, Section of Security Psychiatry, Vestre Viken Hospital Trust, Drammen, Norway
| | - Katharina T. E. Morken
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
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Barker JM, Hawes DJ. Practitioner Review: A core competencies perspective on the evidence-based treatment of child conduct problems. J Child Psychol Psychiatry 2024; 65:124-136. [PMID: 37614104 DOI: 10.1111/jcpp.13882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND The effective treatment of child conduct problems is understood to rely on a range of therapist competencies, yet these have rarely been an explicit focus of research. In this practitioner review, we examine core competencies for the delivery of evidence-based parenting interventions for conduct problems in early-to-middle childhood. These are examined in light of research into the common elements shared by these interventions, literature regarding common challenges in these interventions, and conceptualisations of such competencies in other fields of mental health. METHODS We report on the development of a novel consensus-based model of core competencies for evidence-based practice in this field, based on consultation with an international expert panel. This includes competencies as they apply to complex presentations of conduct problems. RESULTS Despite considerable variation among widely disseminated programmes in terms of content, format and skills-training practices, there is strong consensus among practitioners regarding core competencies. These relate to three broad domains: (a) generic therapeutic competencies; (b) parenting intervention competencies; (c) specific parenting skills/techniques. CONCLUSIONS Practitioners working with conduct problems, particularly complex presentations thereof, require competencies for engaging not only mothers, but fathers and diverse/non-traditional caregivers and other stakeholders, in evidence-based parenting interventions. Moreover, the successful delivery of these interventions necessitates competencies that extend beyond behaviour management and encompass broader aspects of the family system and the wider ecology of the child.
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Affiliation(s)
- Jessica M Barker
- School of Psychology, University of Sydney, Camperdown, NSW, Australia
| | - David J Hawes
- School of Psychology, University of Sydney, Camperdown, NSW, Australia
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Liotti M, Fiorini Bincoletto A, Bizzi F, Tironi M, Charpentier Mora S, Cavanna D, Giovanardi G, Jurist E, Speranza AM, Lingiardi V, Tanzilli A. The catcher in the mind: validation of the brief-mentalized affectivity scale for adolescents in the Italian population. RESEARCH IN PSYCHOTHERAPY (MILANO) 2023; 26:709. [PMID: 38189462 PMCID: PMC10849075 DOI: 10.4081/ripppo.2023.709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 11/03/2023] [Indexed: 01/09/2024]
Abstract
The concept of mentalized affectivity (MA) encompasses the dimensions of identifying, processing, and expressing emotions and describes the process of making sense of and reevaluating one's affects in light of autobiographical memory. This construct was developed within the theoretical framework of mentalization and, due to its interpersonal nature, added further complexity to the emotion regulation construct. This research aimed to examine the factor structure and psychometric properties of the Brief-Mentalized Affectivity Scale for adolescents (B-MAS-A) on an Italian sample of young people (aged 13-19 years). Data were collected using non-probabilistic sampling and an online survey. Participants were asked to complete a large battery of instruments, including the B-MAS-A, the Toronto Alexithymia Scale, the Reflective Functioning Questionnaire, the Epistemic Trust, Mistrust, and Credulity Questionnaire, the Strengths and Difficulties Questionnaire, and the General Self-Efficacy Scale. In study 1, factor analyses carried out on a total sample of 566 adolescents identified 3 distinct dimensions of the same components of MA found in the adult population: i) identifying; ii) processing; iii) expressing emotions. The subscales showed excellent internal consistency. Study 2 (involving a subsample of 288 participants) demonstrated good levels of construct and criterion validity. These results confirm that the B-MAS-A represents a valid and robust instrument for assessing the complex and multifaceted characteristics of MA in adolescents. The B-MAS-A can make a significant contribution to clinical practice and research and encourage systematic studies on MA in psychotherapy, taking into account the developmental stage of adolescence.
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Affiliation(s)
- Marianna Liotti
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome.
| | | | - Fabiola Bizzi
- Department of Educational Sciences, University of Genoa.
| | - Marta Tironi
- Department of Educational Sciences, University of Genoa.
| | | | | | - Guido Giovanardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome.
| | - Elliot Jurist
- Department of Psychology, City College of the City University of New York.
| | - Anna Maria Speranza
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome.
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome.
| | - Annalisa Tanzilli
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome.
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Chau V, Eapen V, Hawkins E, Kohlhoff J. Parenting Characteristics and Callous-Unemotional Traits in Children Aged 0-6 Years: A Systematic Narrative Review. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01634-6. [PMID: 38127204 DOI: 10.1007/s10578-023-01634-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 12/23/2023]
Abstract
There has been a growing interest in research examining the relationship between parenting and child callous-unemotional (CU) traits, particularly in early childhood. This study reviewed evidence from studies that investigated the relationship between parenting characteristics (e.g., caregiving beliefs, attitudes, behaviour or quality, or parental mental health) and callous-unemotional traits in children aged 0 to 6 years. A systematic search conducted according to PRISMA guidelines yielded 27 peer-reviewed articles. Analysis of the included articles suggested that there was strong evidence to support links between child CU traits and parenting characteristics (particularly, parental feelings about their child, warm parenting, and harsh/ inconsistent parenting). Taken together, the results of this review demonstrate the links between both positive and negative dimensions of parenting and CU traits in early childhood; however, mixed findings highlight the need for further research.
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Affiliation(s)
- Vivian Chau
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia.
| | - Valsamma Eapen
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
- Academic Unit of Child Psychiatry, South Western Sydney Local Health District, Sydney, Australia
| | - Erinn Hawkins
- School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Jane Kohlhoff
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
- Karitane, Sydney, Australia
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Locati F, Benzi IMA, Milesi A, Campbell C, Midgley N, Fonagy P, Parolin L. Associations of mentalization and epistemic trust with internalizing and externalizing problems in adolescence: A gender-sensitive structural equation modeling approach. J Adolesc 2023; 95:1564-1577. [PMID: 37500187 DOI: 10.1002/jad.12226] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/27/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Mentalization, operationalized as reflective functioning (RF), allows individuals to interpret actions as caused by intentional mental states. Previous research highlighted the gender-specific associations between adolescents' internalizing and externalizing difficulties and mentalizing impairments. In addition, research suggested that mentalizing facilitates the creation of epistemic trust (ET) to evaluate social information as accurate, reliable, and relevant. However, few investigations explored the concurrent associations between RF, ET, and adolescent psychopathology. METHODS A sample of 447 Italian cisgender adolescents (57% assigned females at birth; age range 12-19 years old; Mage = 15.54, SD = 1.98) self-reported RF (RFQY-5), ET towards mother, father, and peers (IPPA) and mental health problems (YSR-112). Gender-specific structural equation modeling explored the associations between RF, ET, and internalizing/externalizing problems. RESULTS Results suggested an excellent fit for the theoretical model and revealed gender-related associations. In females, findings suggest that ET mediates the association between RF and psychopathology, with indirect associations from RF through ET to lower internalizing and externalizing problems. However, in males, RF and ET display independent associations with psychopathology. CONCLUSION Overall, findings suggest that ET might be a transdiagnostic factor playing different roles associated with adolescent psychopathology. Indeed, links between RF and ET might help to explore gender differences in mental health problems in this developmental phase.
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Affiliation(s)
| | | | - Alberto Milesi
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Chloe Campbell
- Research Department of Clinical, Educational, and Health Psychology, UCL London, and the Anna Freud Centre, London, UK
| | - Nicholas Midgley
- Research Department of Clinical, Educational, and Health Psychology, UCL London, and the Anna Freud Centre, London, UK
| | - Peter Fonagy
- Research Department of Clinical, Educational, and Health Psychology, UCL London, and the Anna Freud Centre, London, UK
| | - Laura Parolin
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
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Hauschild S, Kasper L, Volkert J, Sobanski E, Taubner S. Mentalization-based treatment for adolescents with conduct disorder (MBT-CD): a feasibility study. Eur Child Adolesc Psychiatry 2023; 32:2611-2622. [PMID: 36434148 PMCID: PMC9702655 DOI: 10.1007/s00787-022-02113-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 11/16/2022] [Indexed: 11/26/2022]
Abstract
Conduct disorder (CD) is a common psychiatric disorder in youth characterized by persisting norm-violating or aggressive behavior. Considering high individual and societal burden, feasible and effective psychotherapeutic treatment is desirable. Yet, treatments and research in this patient group are scarce. This study investigates the feasibility of mentalization-based treatment for adolescents with CD (MBT-CD) in terms of acceptability of MBT-CD and scientific assessments by participants as well as necessary organizational resources to conduct a consecutive randomized controlled trial (RCT). Recruitment, adherence and treatment session numbers were descriptively analyzed. Treatment evaluation interviews were qualitatively analyzed. A subset of sessions of therapists without prior MBT experience was rated for MBT adherence. Quantitative data were used to plan a consecutive RCT. Pre to post treatment changes in diagnosis and self-reported aggression, mentalizing and personality functioning were preliminarily analyzed. N = 45 adolescents with CD were recruited. 43% dropped out. Acceptance of scientific assessments was somewhat lower than therapy adherence (questionnaires filled out by ~ 80% of adolescents in treatment), and low at follow-up (25% of treatment completers). Mean session number was 30.3. Most treatment completers were satisfied with MBT-CD. Referrals mainly came from child and youth services and psychiatry. Nine of 16 sessions rated for MBT adherence were adherent. A priori sample size estimation for a prospective RCT with a drop-out rate of 43% yielded a sample of N = 158 to detect an effect f = .15 with 80% power in a repeated measures ANOVA. Pre-post analyses revealed diagnostic improvement in 68%. Of self-reported data, empathy pathology improved. Findings provide a sound basis for a consecutive feasibility and pilot RCT. TRIAL REGISTRATION: Clinicaltrials.gov, registration number NCT02988453, November 30, 2016, https://clinicaltrials.gov/ct2/show/NCT02988453.
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Affiliation(s)
- Sophie Hauschild
- Institute for Psychosocial Prevention, University Hospital Heidelberg, Heidelberg, Germany.
- Psychological Institute, University of Heidelberg, Heidelberg, Germany.
| | - Lea Kasper
- Institute for Psychosocial Prevention, University Hospital Heidelberg, Heidelberg, Germany
- Psychological Institute, University of Heidelberg, Heidelberg, Germany
| | - Jana Volkert
- Department of Psychology, Medical School Berlin, Berlin, Germany
| | - Esther Sobanski
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Johannes Gutenberg University Mainz, Mainz, Germany
- Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University Hospital Heidelberg, Heidelberg, Germany
- Department of Child and Youth Psychiatry, Lucerne Psychiatry, Lucerne, Switzerland
| | - Svenja Taubner
- Institute for Psychosocial Prevention, University Hospital Heidelberg, Heidelberg, Germany
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Pischiutta L, Garzitto M, Zamparutti G, Moratti E, Albert U, Colizzi M, Balestrieri M. Mentalization in young patients undergoing opioid agonist treatment: Implications for clinical management. Addict Behav Rep 2023; 17:100497. [PMID: 37249942 PMCID: PMC10212784 DOI: 10.1016/j.abrep.2023.100497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 05/08/2023] [Accepted: 05/13/2023] [Indexed: 05/31/2023] Open
Abstract
Background Mentalization is the ability to use internal mental states to manage and understand one's own and others' behavior. Inefficient mentalization has been associated to poor neuropsychological outcomes, including substance use disorder (SUD) and addiction. However, studies primarily investigating mentalization in SUD are lacking. Methods Using the Reflective Functioning Questionnaire (RFQ), the Measurements in the Addictions for Triage and Evaluation, version 2.1 (MATE-IT-2.1), and the Mini International Neuropsychiatric Interview, 7th edition (MINI-7), an outpatient assessment investigated inefficient mentalization (i.e., 'hypo-mentalization' or 'uncertainty': concrete thinking with poor attribution of mental states; 'hyper-mentalization' or 'certainty': rigid and biased attribution of mental states) and socio-demographic and clinical characteristics, including SUD-related symptoms and any other psychiatric comorbidity, among opioid addiction (OA) patients in Opioid Agonist Treatment (OAT). Results Thirty-seven consecutive OA patients in OAT (female, 45.9 %; age, M ± SD, 24.3 ± 3.55) were recruited. Patients' mentalization differed from normative data, in terms of higher uncertainty and lower certainty scores. Also, higher uncertainty score was found among younger patients and in those with the most severe SUD in terms of craving and need for care. Finally, lower certainty score was found in those with a more severe substance abuse, previous contacts with pediatric mental-health services, and receiving a therapeutic community support. Conclusions OA patients with inefficient mentalization present with a higher burden in terms of SUD severity, comorbidities, psychosocial disabilities, and service use, with important public health implications. Interventions targeting mentalization may have positive repercussions in preventing SUD, mitigating its severity, and containing its healthcare and social costs.
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Affiliation(s)
- Livia Pischiutta
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
- Drug Addiction Service, Department of Addiction, University Health Integrated Agency, 33100 Udine, Italy
| | - Marco Garzitto
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Giuliano Zamparutti
- Drug Addiction Service, Department of Addiction, University Health Integrated Agency, 33100 Udine, Italy
| | - Enrico Moratti
- Drug Addiction Service, Department of Addiction, University Health Integrated Agency, 33100 Udine, Italy
| | - Umberto Albert
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34149 Trieste, Italy
| | - Marco Colizzi
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Matteo Balestrieri
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
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Zhang W, Li Y, Li L, Hinshaw S, Lin X. Vicious cycle of emotion regulation and ODD symptoms among Chinese school-age children with ODD: a random intercept cross-lagged panel model. Child Adolesc Psychiatry Ment Health 2023; 17:47. [PMID: 37016426 PMCID: PMC10074899 DOI: 10.1186/s13034-023-00579-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/16/2023] [Indexed: 04/06/2023] Open
Abstract
A strong link between children's emotion regulation and oppositional defiant disorder (ODD) symptoms has been documented; however, the within-person mechanisms remain unclear. Based on the self-control theory and self-regulation theory, our study investigated the longitudinal, bidirectional relationship between emotion regulation and ODD symptoms in school-age children with ODD using parent- and teacher-reported data, respectively. A total of 256 Chinese elementary school students participated in a three-wave longitudinal study spanning two years. We used the random intercept cross-lagged panel model (RI-CLPM) to investigate the concurrent and longitudinal associations between emotion regulation and ODD symptoms. Results from the RI-CLPMs revealed that ODD symptoms were negatively correlated with emotion regulation and positively correlated with emotion lability/negativity at both the between-person and within-person levels across settings. Additionally, in the school setting, emotion regulation negatively predicted subsequent ODD symptoms but not vice versa, whereas emotion lability/negativity was bidirectionally associated with ODD symptoms over time. The longitudinal associations of ODD symptoms with emotion regulation and lability/negativity were not observed in the home setting. These findings suggest a circular mechanism between children's emotion regulation and ODD symptoms and support the view that emotion regulation, particularly emotion lability/negativity, plays an important role in the development of ODD symptoms.
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Affiliation(s)
- Wenrui Zhang
- Institute of Developmental Psychology, School of Psychology, Beijing Normal University, Beijing, 100875, China
| | - Yanbin Li
- Department of Psychology, College and Graduate School of Arts and Sciences, University of Virginia, Charlottesville, VA, USA
| | - Longfeng Li
- T. Denny Sanford School of Social and Family Dynamics, Arizona State University, Tempe, AZ, USA
| | - Stephen Hinshaw
- Department of Psychology, University of California, Berkeley, CA, USA
| | - Xiuyun Lin
- Institute of Developmental Psychology, School of Psychology, Beijing Normal University, Beijing, 100875, China.
- Beijing Key Laboratory of Applied Experimental Psychology, School of Psychology, Beijing Normal University, Beijing, China.
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Goulter N, Balanji S, Davis BA, James T, McIntyre CL, Smith E, Thornton EM, Craig SG, Moretti MM. Psychometric Evaluation of the Affect Regulation Checklist: Clinical and Community Samples, Parent-Reports and Youth Self-Reports. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2023; 33:344-360. [PMID: 35699159 DOI: 10.1111/jora.12779] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The Affect Regulation Checklist (ARC) was designed to capture affect dysregulation, suppression, and reflection. Importantly, affect dysregulation has been established as a transdiagnostic mechanism underpinning many forms of psychopathology. We tested the ARC psychometric properties across clinical and community samples and through both parent-report and youth self-report information. Clinical sample: Participants included parents (n = 814; Mage = 43.86) and their child (n = 608; Mage = 13.98). Community sample: Participants included independent samples of parents (n = 578; Mage = 45.12) and youth (n = 809; Mage = 15.67). Exploratory structural equation modeling supported a three-factor structure across samples and informants. Dysregulation was positively associated with all forms of psychopathology. In general, suppression was positively associated with many forms of psychopathology, and reflection was negatively associated with externalizing problems and positively associated with internalizing problems.
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12
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Adolescent Problem Gambling and Gaming in the Hierarchical Structure of Psychopathology. Int J Ment Health Addict 2023. [DOI: 10.1007/s11469-023-01032-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
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Zhang JL, Zhou N, Song KR, Zou BW, Xu LX, Fu Y, Geng XM, Wang ZL, Li X, Potenza MN, Nan Y, Zhang JT. Neural activations to loss anticipation mediates the association between difficulties in emotion regulation and screen media activities among early adolescent youth: A moderating role for depression. Dev Cogn Neurosci 2022; 58:101186. [PMID: 36516611 PMCID: PMC9764194 DOI: 10.1016/j.dcn.2022.101186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Screen media activities (SMAs; e.g., watching videos, playing videogames) have become increasingly prevalent among youth as ways to alleviate or escape from negative emotional states. However, neural mechanisms underlying these processes in youth are incompletely understood. METHOD Seventy-nine youth aged 11-15 years completed a monetary incentive delay task during fMRI scanning. Neural correlates of reward/loss processing and their associations with SMAs were explored. Next, brain activations during reward/loss processing in regions implicated in the processing of emotions were examined as potential mediating factors between difficulties in emotion regulation (DER) and engagement in SMAs. Finally, a moderated mediation model tested the effects of depressive symptoms in such relationships. RESULT The emotional components associated with SMAs in reward/loss processing included activations in the left anterior insula (AI) and right dorsolateral prefrontal cortex (DLPFC) during anticipation of working to avoid losses. Activations in both the AI and DLPFC mediated the relationship between DER and SMAs. Moreover, depressive symptoms moderated the relationship between AI activation in response to loss anticipation and SMAs. CONCLUSION The current findings suggest that DER link to SMAs through loss-related brain activations implicated in the processing of emotions and motivational avoidance, particularly in youth with greater levels of depressive symptoms. The findings suggest the importance of enhancing emotion-regulation tendencies/abilities in youth and, in particular, their regulatory responses to negative emotional situations in order to guide moderate engagement in SMAs.
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Affiliation(s)
- Jia-Lin Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Nan Zhou
- Faculty of Education, University of Macau, Macau, China
| | - Kun-Ru Song
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Bo-Wen Zou
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Lin-Xuan Xu
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Yu Fu
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Xiao-Min Geng
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Zi-Liang Wang
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Xin Li
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Marc N Potenza
- Department of Psychiatry and Child Study Center, Yale University School of Medicine, New Haven, CT, USA; Connecticut Council on Problem Gambling, Wethersfield, CT, USA; Connecticut Mental Health Center, New Haven, CT, USA; Department of Neuroscience and Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - Yun Nan
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China.
| | - Jin-Tao Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China.
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14
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Moore MN, Planalp EM, Van Hulle CA, Goldsmith HH. Pediatric assessment of Research Domain Criteria positive and negative valence systems: Partial genetic mediation of links to problem behaviors. JOURNAL OF PSYCHOPATHOLOGY AND CLINICAL SCIENCE 2022; 131:626-640. [PMID: 35901392 PMCID: PMC9346929 DOI: 10.1037/abn0000652] [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] [Indexed: 06/15/2023]
Abstract
We use the highly structured Laboratory-Temperament Assessment Battery to measure behaviors that map onto the Research Domain Criteria (RDoC) positive and negative valence systems. Using a birth record-based sample (N = 1374 individual twins; mean age 7.7 years), we created composites of observed behavior reflecting the RDoC constructs Reward Responsiveness, Frustrative Nonreward, Loss, and Fear. Next, we related the RDoC constructs concurrently and longitudinally to problem behaviors, measured using parent-report on the Health Behavior Questionnaire and symptom counts from the Diagnostic Interview Schedule for Children, Version IV (DISC-IV; reflecting DSM-IV). The four pediatric RDoC positive and negative valence system measures, especially Reward Responsiveness, Frustrative Nonreward, and Loss, were heritable and modestly but plausibly related to traditional DSM-based measures in a transdiagnostic manner. The modest predictions from RDoC measures to DSM-based measures were largely genetically mediated, although relationships with aggressive and oppositional behaviors were also influenced by common environmental factors. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Mollie N Moore
- Department of Psychology, University of Wisconsin-Madison
| | | | - Carol A Van Hulle
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison
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15
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Bonham MD, Hawkins E, Waters AM, Shanley DC. Can't Stop, Won't Stop? The Role of Inhibitory Control and Callous-Unemotional Traits in Childhood Conduct Problems and Aggression. Dev Neuropsychol 2022; 47:210-225. [PMID: 35470719 DOI: 10.1080/87565641.2022.2069770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 11/03/2022]
Abstract
Disruptive behaviors such as conduct problems and aggression are some of the most prevalent childhood psychological concerns. The etiology of disruptive behaviors is heterogenous and the relationships between the myriad risk factors that contribute to these problems are not yet fully understood. This study examined the relationship between inhibitory control and callous-unemotional traits (CU traits) with conduct problems and aggression in a community sample of children (aged 6 to 11 years). Caregivers (n= 148) completed a survey assessing a range of known risk factors (including hyperactivity and inattention). Children were found to display more conduct problems and aggression if they had greater difficulties with inhibitory control and a higher number of CU traits. Interestingly, when children had CU traits, inhibitory control difficulties exacerbated the severity of conduct problems (but not aggression). Differences in severity between conduct problems and aggression highlight the unique relationships between risk factors such as inhibitory control and CU traits, and lay the groundwork for future studies to explore the trajectories of this relationship.
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Affiliation(s)
- Mikaela D Bonham
- School of Applied Psychology, Menzies Health Institute of Queensland, Griffith University, Mount Gravatt and Southport, Queensland, Australia
| | - Erinn Hawkins
- School of Applied Psychology, Menzies Health Institute of Queensland, Griffith University, Mount Gravatt and Southport, Queensland, Australia
| | - Allison M Waters
- School of Applied Psychology, Menzies Health Institute of Queensland, Griffith University, Mount Gravatt and Southport, Queensland, Australia
| | - Dianne C Shanley
- School of Applied Psychology, Menzies Health Institute of Queensland, Griffith University, Mount Gravatt and Southport, Queensland, Australia
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16
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Aebi M, Haynes M, Bessler C, Hasler G. Associations of interpersonal trust with juvenile offending/conduct disorder, callous-unemotional traits, and criminal recidivism. Sci Rep 2022; 12:7594. [PMID: 35534545 PMCID: PMC9085823 DOI: 10.1038/s41598-022-11777-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 04/01/2022] [Indexed: 11/18/2022] Open
Abstract
Interpersonal trust has been described as a core dimension of cooperative, mutually beneficial interpersonal relationships but it is unclear if it is related to antisocial behaviours in youth. The present study aimed at analysing a subsample of male juveniles who committed serious violent offenses and met criteria of conduct disorder (JO/CD), and a subsample of healthy controls (HC) using a series of trust games (TGs). Twenty-four male JO/CD and 24 age matched male HC performed a series of eight one-shot TGs against different unknown human respectively computer opponents. Mixed model analyses found a non-significant trend that JO/CD invested less points than HC during TGs. In the subsample of JO/CD, the overall investment in TGs was found to be negatively associated with self-reported uncaring behaviours and officially reported general re-offenses. Our findings suggest some indication of an impaired ability of JO/CD to initiate mutually trusting relationships to others that should be addressed in further research. Trust is a promising factor to predict general criminal recidivism and can be a target for treatment of juveniles who committed violent offenses, for example through the building of stable relationships to care givers. This study encourages future studies to investigate the effects of trust-increasing psychosocial interventions.
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Affiliation(s)
- Marcel Aebi
- Research and Development, Corrections and Rehabilitation, Department of Justice and Home Affairs, Canton of Zurich, Hohlstr. 552, 8090, Zurich, Switzerland. .,Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich/University of Zurich, Zurich, Switzerland.
| | - Melanie Haynes
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy Bern, Bern, Switzerland
| | - Cornelia Bessler
- Research and Development, Corrections and Rehabilitation, Department of Justice and Home Affairs, Canton of Zurich, Hohlstr. 552, 8090, Zurich, Switzerland.,Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich/University of Zurich, Zurich, Switzerland
| | - Gregor Hasler
- Unit of Psychiatry Research, University of Fribourg, Fribourg, Switzerland
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17
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Liu B, Yang Y, Geng J, Cai T, Zhu M, Chen T, Xiang J. Harsh Parenting and Children's Aggressive Behavior: A Moderated Mediation Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042403. [PMID: 35206591 PMCID: PMC8878192 DOI: 10.3390/ijerph19042403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/01/2022] [Accepted: 02/16/2022] [Indexed: 11/16/2022]
Abstract
Harsh parenting and its effect on children’s aggressive behavior has received attention from researchers, however few studies have considered the role of the emotional process. This study aims to examine the relationship between harsh parenting, children’s aggressive behavior, normative beliefs about aggression, and regulatory emotional self-efficacy, alongside their mechanism of interplay. A sample of 235 senior primary school students in Beijing were recruited as participants by using the Harsh Parenting Scale, the Normative Beliefs about Aggression Scale, the Buss–Warren Aggression Questionnaire, and the Regulatory Emotional Self-Efficacy Scale. Results indicated that: (1) Harsh parenting had a significant positive predictive effect on children’s aggressive behavior after controlling gender; (2) normative beliefs about the aggression of children mediated the relationship between harsh parenting and children’s aggressive behavior; and (3) regulatory emotional self-efficacy had moderating effects both the mediation model of normative beliefs about the aggression of children and in the direct predictive model of harsh parenting on children’s aggressive behavior. The results are not only helpful to understand the relationship between harsh parenting and children’s aggressive behavior from the perspective of an integrated model of emotion processes and cognition, but also provide a new practical way to prevent and intervene in children’s aggressive behavior in the future.
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18
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Taubner S, Bertsch K, Protić S, Fehr T. Editorial: Unlearning of Aggressive Behavior and Mechanisms of Change. Front Psychiatry 2022; 13:919122. [PMID: 35757217 PMCID: PMC9214206 DOI: 10.3389/fpsyt.2022.919122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/17/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Svenja Taubner
- Institute for Psychosocial Prevention, University Hospital of the University Heidelberg, Heidelberg, Germany
| | - Katja Bertsch
- Department of Psychology, Ludwig-Maximilians-University Munich, Munich, Germany.,NeuroImaging Core Unit Munich (NICUM), University Hospital LMU, Munich, Germany
| | - Sonja Protić
- Institute of Criminological and Sociological Research, University of Belgrade, Belgrade, Serbia
| | - Thorsten Fehr
- Department of Neuropsychology, Center for Cognitive Sciences, University of Bremen, Bremen, Germany.,Center for Advanced Imaging, Universities of Bremen and Magdeburg, Bremen, Germany
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19
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Conduct problems among children in low-income, urban neighborhoods: A developmental psychopathology- and RDoC-informed approach. Dev Psychopathol 2021. [DOI: 10.1017/s0954579421001103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractConduct problems are associated with numerous negative long-term psychosocial sequelae and are among the most frequent referrals for children's mental health services. Youth residing in low-income, urban communities are at increased risk for conduct problems, but not all youth in these environments develop conduct problems, suggesting heterogeneity in risk and resilience processes and developmental pathways. The present study used a developmental psychopathology- and Research Domain Criteria (RDoC)-informed approach for conceptualizing risk and resilience for conduct problems among children from low-income, urban neighborhoods. Participants were 104 children (M = 9.93 ± 1.22 years; 50% male; 96% African American, 4% Latinx). We assessed four constructs reflecting cognitive and neurobiological processes associated with conduct problems using multiple levels of analysis and informants: autonomic nervous system reactivity, limbic system/orbitofrontal cortical functioning, dorsolateral prefrontal cortical functioning, and conduct problems. Latent profile analysis identified four profiles: typically developing (TD, n = 34); teacher-reported conduct problems (TCP, n = 14); emotion processing (EP, n = 27); and emotion expression recognition (EER, n = 29). External validation analyses demonstrated that profiles differed on various indices of conduct problems in expected ways. The EP profile exhibited lower levels of emotional lability and callous–unemotional behaviors, and higher levels of prosocial behavior. The TD profile demonstrated elevated emotional lability. Implications for etiological and intervention models are presented.
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20
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Bizzi F, Riva A, Borelli JL, Charpentier-Mora S, Bomba M, Cavanna D, Nacinovich R. The Italian version of the Reflective Functioning Questionnaire: Validity within a sample of adolescents and associations with psychological problems and alexithymia. J Clin Psychol 2021; 78:503-516. [PMID: 34273902 PMCID: PMC9290635 DOI: 10.1002/jclp.23218] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 03/25/2021] [Accepted: 06/30/2021] [Indexed: 11/23/2022]
Abstract
Objectives This study aims to test the psychometric proprieties of the Reflective Functioning Questionnaire (RFQ) applied to younger (13–16 years) and older (17–20 years) Italian adolescents examining (1) the factorial structure of RFQ; (2) its invariance across age and sex; (3) correlations between RFQ subscale scores, as well as the associations of the RFQ with (4) psychological problems and alexithymia dimensions. Methods A cross‐sectional study was conducted with 593 adolescents between the ages of 13 and 20 years old recruited from the community within Italy. These participants completed the RFQ, Symptom Checklist‑90, and Toronto Alexithymia Scale. Results The two‐factor structure of the RFQ was confirmed. However, higher internal consistency of RFQ was obtained by removing two items that seemed problematic within this sample. Using a six‐item version of RFQ, the two‐factor structure was invariant across adolescent age and sex. Significant correlations among RFQ subscale scores, and between RFQ subscales with both psychological problems and alexithymia dimensions were found. Conclusions Preliminary results reveal a short version of RFQ (six‐item) is a suitable measure to assess mentalizing in adolescents in the Italian context.
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Affiliation(s)
- Fabiola Bizzi
- Department of Educational Science, University of Genoa, Genoa, Italy
| | - Anna Riva
- Clinic of Child and Adolescent Neuropsychiatry, San Gerardo Hospital-Monza, University of Milan-Bicocca, Monza, Italy
| | - Jessica L Borelli
- Department of Psychology and Social Behavior, University of California, Irvine, California, USA
| | | | - Monica Bomba
- Clinic of Child and Adolescent Neuropsychiatry, San Gerardo Hospital-Monza, University of Milan-Bicocca, Monza, Italy
| | - Donatella Cavanna
- Department of Educational Science, University of Genoa, Genoa, Italy
| | - Renata Nacinovich
- Clinic of Child and Adolescent Neuropsychiatry, San Gerardo Hospital-Monza, University of Milan-Bicocca, Monza, Italy
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21
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Taubner S, Hauschild S, Kasper L, Kaess M, Sobanski E, Gablonski TC, Schröder-Pfeifer P, Volkert J. Mentalization-based treatment for adolescents with conduct disorder (MBT-CD): protocol of a feasibility and pilot study. Pilot Feasibility Stud 2021; 7:139. [PMID: 34215323 PMCID: PMC8252214 DOI: 10.1186/s40814-021-00876-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 06/21/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Conduct disorder (CD) is a complex mental disorder characterized by severe rule-breaking and aggressive behavior. While studies have shown that several therapeutic interventions are effective in treating CD symptoms, researchers call for treatments based on etiological knowledge and potential patho-mechanisms. Mentalization-based treatment (MBT) may represent such a treatment approach: Studies have shown that individuals with CD show mentalizing deficits and that mentalizing might represent a protective factor against the development of the disorder. As MBT focuses on the understanding of social behavior in terms of mental states, fostering mentalizing might help CD individuals to (re)gain an adaptive way of coping with negative emotions especially in social interactions and thus reduce aggressive behavior. For this purpose, MBT was adapted for adolescents with CD (MBT-CD). This is a protocol of a feasibility and pilot study to inform the planning of a prospective RCT. The primary aim is to estimate the feasibility of an RCT based on the acceptability of the intervention and the scientific assessments by CD individuals and their families indicated by quantitative and qualitative data, as well as based on necessary organizational resources to conduct an RCT. The secondary aim is to investigate the course of symptom severity and mentalizing skills. METHODS The bi-center study is carried out in two outpatient settings associated with university hospitals (Heidelberg and Mainz) in Germany. Adolescents aged between 11 and 18 years with a CD or oppositional defiant disorder (ODD) diagnosis are included. Participants receive MBT-CD for 6 to 12 months. The primary outcome of the feasibility study (e.g., recruitment and adherence rates) will be descriptively analyzed. Multilevel modeling will be used to investigate secondary outcome data. DISCUSSION Fostering the capacity to mentalize social interactions triggering non-mentalized, aggressive behavior might help CD individuals to behave more adaptively. The feasibility trial is essential for gathering information on how to properly conduct MBT-CD including appropriate scientific assessments in this patient group, in order to subsequently investigate the effectiveness of MBT-CD in an RCT. TRIAL REGISTRATION ClinicalTrials.gov , NCT02988453 . November 30, 2016 SOURCES OF MONETARY SUPPORT: Dietmar Hopp Stiftung, Heidehof Stiftung RECRUITMENT STATUS: Recruitment complete and intervention complete, follow-up assessments ongoing (Heidelberg). Recruitment and assessments ongoing (Mainz). PRIMARY SPONSOR, PRINCIPAL INVESTIGATOR, AND LEAD INVESTIGATOR IN HEIDELBERG: Svenja Taubner is responsible for the design and conduct of MBT-CD intervention and feasibility and pilot study, preparation of protocol and revisions, and publication of study results. SECONDARY SPONSOR AND LEAD INVESTIGATOR IN MAINZ Esther Sobanski is responsible for the recruitment and data collection in the collaborating center Mainz RECRUITMENT COUNTRY: Germany HEALTH CONDITION STUDIED: Conduct disorder, oppositional defiant disorder INTERVENTION: Mentalization-based treatment for conduct disorder (MBT-CD): MBT-CD is an adaptation of MBT for Borderline Personality Disorder. This manualized psychodynamic psychotherapy focuses on increasing mentalizing, i.e., the ability to understand behavior in terms of mental states, in patients. MBT-CD includes weekly individual sessions with the patient and monthly family sessions. KEY INCLUSION AND EXCLUSION CRITERIA Included are adolescent individuals with a diagnosis of conduct disorder or oppositional defiant disorder aged between 11 and 18 years. STUDY TYPE Feasibility and pilot study (single-group) DATE OF FIRST ENROLLMENT: 19.01.2017 STUDY STATUS: The trial is currently in the follow-up assessment phase in Heidelberg and in the recruitment and treatment phase in Mainz. PRIMARY OUTCOMES Acceptability of MBT-CD intervention (as indicated by recruitment rates, completion rates, drop-out rates, treatment duration, oral evaluation), acceptability of scientific assessments (as indicated by adherence, missing data, oral evaluation), and necessary organizational resources (scientific personnel, recruitment networks, MBT-CD training and supervision) to estimate feasibility of an RCT SECONDARY OUTCOMES: Adolescents' symptom severity and mentalizing ability PROTOCOL VERSION: 20.08.2020, version 1.0.
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Affiliation(s)
- Svenja Taubner
- Institute for Psychosocial Prevention, University Hospital Heidelberg, University of Heidelberg, Bergheimer Str. 56, D-69115 Heidelberg, Germany
| | - Sophie Hauschild
- Institute for Psychosocial Prevention, University Hospital Heidelberg, University of Heidelberg, Bergheimer Str. 56, D-69115 Heidelberg, Germany
- Psychological Institute, University of Heidelberg, Heidelberg, Germany
| | - Lea Kasper
- Institute for Psychosocial Prevention, University Hospital Heidelberg, University of Heidelberg, Bergheimer Str. 56, D-69115 Heidelberg, Germany
| | - Michael Kaess
- Clinic of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Esther Sobanski
- Department of Pediatric and Adolescent Psychiatry and Psychotherapy, University Medical Center Johannes Gutenberg University Mainz, Mainz, Germany
| | | | - Paul Schröder-Pfeifer
- Institute for Psychosocial Prevention, University Hospital Heidelberg, University of Heidelberg, Bergheimer Str. 56, D-69115 Heidelberg, Germany
| | - Jana Volkert
- Institute for Psychosocial Prevention, University Hospital Heidelberg, University of Heidelberg, Bergheimer Str. 56, D-69115 Heidelberg, Germany
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22
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[What Did You Like About the Therapy? - A Qualitative Study on the Evaluation of Mentalization-Based Treatment for Adolescents with Conduct Disorder]. Prax Kinderpsychol Kinderpsychiatr 2021; 70:386-402. [PMID: 34187334 DOI: 10.13109/prkk.2021.70.5.386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Psychotherapeutic treatment for adolescents with conduct disorder (CD) is considered difficult for various reasons. On the one hand, patients frequently lack psychological strain, and striving for autonomy is part of typical adolescent development. On the other hand, therapists can react aversively to delinquent and violent behavior, and insufficient psychological models explaining aetiology and maintenance of symptoms can impede treatment of adolescents with CD. Mentalization-Based Therapy for adolescents with CD (MBT-CD) was developed with the aim of addressing these difficulties and improving psychotherapeutic treatment for this patient group. MBT-CD focuses on the promotion of the adolescents' autonomy by increasing their scope of action via an improvement of mentalizing ability. The aim of this qualitative study is to investigate the acceptance of MBT-CD by the adolescents in terms of their experience with MBT-CD and thus obtain information about aspects which enhance therapy motivation for this group of patients. For this purpose, we conducted semi-structured interviews with twelve adolescents after completion of therapy assessing their subjective therapy evaluation. Qualitative content analysis was used to analyze the data. The results show both helpful and hindering aspects of the mentalization-based interventions. In addition, the monthly family sessions included in the therapy were regarded as important. Adolescents also regarded emotion regulation strategies as helpful. Implications for the treatment of adolescents with CD are discussed.
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23
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Luyten P, Fonagy P. Integrating and differentiating personality and psychopathology: A psychodynamic perspective. J Pers 2021; 90:75-88. [PMID: 34170512 DOI: 10.1111/jopy.12656] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 01/18/2023]
Abstract
Several strands of research converge to suggest that personality and psychopathology can be integrated in the form of a hierarchical model of individual differences. The notion that personality and psychopathology are intrinsically linked has a long tradition within psychodynamic approaches. In this article, we first summarize empirical evidence supporting two related key assumptions of psychodynamic approaches to personality and psychology: that a developmental, person-centered approach is needed to complement a static, disorder-centered approach in the conceptualization and treatment of psychopathology; and that personality and psychopathology are best conceptualized as dynamic attempts at adaptation. Research in each of these areas supports the notion that personality and psychopathology are difficult to separate and may be moderated by severity (i.e., general psychopathology) such that increasing levels of severity result in increased intrinsic coupling between the two. We then discuss these findings in the context of a newly emerging social-communicative approach to human development that suggests that personality and psychopathology are better conceptualized in terms of a disorder of social communication, and that the purported rigidity and stability typically attributed to them are largely explained by the stability of the environmental mechanisms that underpin them, rather than by stable intrapersonal traits. The implications of these new views for the future of the science of personality and psychopathology, and for treatment strategies, are discussed.
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Affiliation(s)
- Patrick Luyten
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.,Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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24
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Herpers PCM, Neumann JEC, Staal WG. Treatment Refractory Internalizing Behaviour Across Disorders: An Aetiological Model for Severe Emotion Dysregulation in Adolescence. Child Psychiatry Hum Dev 2021; 52:515-532. [PMID: 32748274 PMCID: PMC8113221 DOI: 10.1007/s10578-020-01036-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 05/28/2020] [Accepted: 07/21/2020] [Indexed: 12/17/2022]
Abstract
Auto-aggressive behaviour, especially treatment refractory suicidality in adolescents with psychiatric disorders, may be challenging to clinicians. In search of therapeutic possibilities, we have integrated current opinions regarding causality and interdependency of suicidality and auto-aggressive behaviour across disorders within the HiTOP framework. We propose a developmental model regarding these unsettling behaviours in youths that may help to guide future directions for research and interventions. We argue that the interdependent development of biologic factors, attachment, moral reasoning and emotion regulation in an overprotective environment may lead to social anxiety and later during development to emotion dysregulation and severe internalizing behaviour disorders. To optimize treatment efficacy for both internalizing and externalizing behaviour, we emphasize the importance transdiagnostic interventions, such as addressing non-compliance, restoration of trust between parents and their child, and limitation of avoidance behaviour. These may be seen as higher order interventions within the HiTOP framework.
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Affiliation(s)
- Pierre C M Herpers
- Karakter Child and Adolescent Psychiatry, University Centre, Reinier Postlaan 12, Nijmegen, 6525 GC, The Netherlands.
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Kapittelweg 29, Nijmegen, 6525 EN, The Netherlands.
| | - Josephine E C Neumann
- Karakter Child and Adolescent Psychiatry, University Centre, Reinier Postlaan 12, Nijmegen, 6525 GC, The Netherlands
| | - Wouter G Staal
- Karakter Child and Adolescent Psychiatry, University Centre, Reinier Postlaan 12, Nijmegen, 6525 GC, The Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Geert Grooteplein 10, Nijmegen, 6525 GA, The Netherlands
- Faculty of Social Sciences, Leiden Institute for Brain and Cognition, Postzone C2-5, P.O. Box 9600, Leiden, 2300 RC, The Netherlands
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25
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Schwarzer NH, Nolte T, Fonagy P, Gingelmaier S. Mentalizing mediates the association between emotional abuse in childhood and potential for aggression in non-clinical adults. CHILD ABUSE & NEGLECT 2021; 115:105018. [PMID: 33676103 DOI: 10.1016/j.chiabu.2021.105018] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 02/01/2021] [Accepted: 02/22/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Emotional abuse in childhood has been linked to a higher expression of aggressive behavior in adulthood. The identification of protective factors that mitigate this association is needed. Mentalizing-the capacity to understand behavior in terms of intentional mental states-appears to be a promising candidate factor that possibly modifies maladaptive consequences of early emotional abuse. OBJECTIVE This study investigated associations between the history of emotional abuse, aggressive behavior in adulthood and mentalizing capacities in a non-clinical sample of adults. METHODS 214 healthy adults completed questionnaires measuring retrospectively rated experiences of emotional abuse in childhood, mentalizing capacities and aggressive behavior in a cross-sectional design. RESULTS Results indicated associations between emotional abuse in childhood, uncertainty about mental states, and aggressive behavior in adulthood. Moreover, certainty about mental states counteracted the negative effect of emotional abuse and partially mediated the associations between emotional abuse and aggressive behavior in adulthood. CONCLUSION This study extends current research and sheds further light on the relationship between emotional abuse in childhood, the health-promoting capacity of mentalizing, and aggressive behavior in non-clinical adults.
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Affiliation(s)
| | - Tobias Nolte
- Anna Freud National Centre for Children and Families, London, UK; University College London, UK
| | - Peter Fonagy
- Anna Freud National Centre for Children and Families, London, UK; University College London, UK
| | - Stephan Gingelmaier
- Pädagogische Hochschule Ludwigsburg, Fakultät III für Sonderpädagogik, Germany
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Nujić D, Musić Milanović S, Milas V, Miškulin I, Ivić V, Milas J. Association between child/adolescent overweight/obesity and conduct disorder: A systematic review and meta-analysis. Pediatr Obes 2021; 16:e12742. [PMID: 33348469 DOI: 10.1111/ijpo.12742] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 09/12/2020] [Accepted: 09/28/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Research findings of the association and its pattern between obesity and psychiatric/psychological comorbidities are not consistent across the types of comorbidities or the study subgroups. OBJECTIVES We aimed to perform meta-analysis of cross-sectional studies and longitudinal studies analysing obesity as a risk factor for conduct disorder in order to assess the association between child/adolescent overweight/obesity and conduct disorder. METHODS Systematic literature search, study selection and data extraction were performed independently by the two authors. Data were analysed by Comprehensive Meta-analysis software. RESULTS Analysis of 13 high-quality cross-sectional studies including 79 027 children and adolescents indicated a significant association between overweight/obesity and conduct disorder among children and adolescents (OR 1.32 [95% CI, 1.18-1.49], I2 = 86.68), with no publication bias. Subgroup analyses yielded a significant difference (P < .01) between boys and girls. Analysis of four low- to moderate-quality longitudinal studies (OR 1.11 [95% CI, 0.89-1.38], I2 = 57.69) showed no prospective association between overweight/obesity and conduct disorder. Subgroup analysis according to gender revealed a significant positive association for boys and negative association for girls. CONCLUSIONS Based on the high-quality cross-sectional data, overweight and obesity are associated with conduct disorder among children and adolescents, affecting boys more frequently than girls. Results of the longitudinal analysis indicated possible association in boys, while girls seem to be protected from conduct disorder. However, these results are very unreliable, indicating the need of well-designed longitudinal studies to elucidate the pattern of association between these disorders.
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Affiliation(s)
- Danijela Nujić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.,Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Sanja Musić Milanović
- Division for Health Promotion, Croatian Institute of Public Health, Zagreb, Croatia.,School of Medicine, Andrija Štampar School of Public Health, University of Zagreb, Zagreb, Croatia
| | - Vesna Milas
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.,Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.,Department of Pediatrics, Osijek University Hospital Centre, Osijek, Croatia
| | - Ivan Miškulin
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Vedrana Ivić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Josip Milas
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.,Department of Epidemiology, Institute of Public Health of Osijek-Baranja County, Osijek, Croatia
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Talia A, Duschinsky R, Mazzarella D, Hauschild S, Taubner S. Epistemic Trust and the Emergence of Conduct Problems: Aggression in the Service of Communication. Front Psychiatry 2021; 12:710011. [PMID: 34630177 PMCID: PMC8494977 DOI: 10.3389/fpsyt.2021.710011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/02/2021] [Indexed: 11/13/2022] Open
Abstract
Fonagy and colleagues have recently proposed that deficits in the capacity for epistemic trust (i. e., the expectation that interpersonal communication is relevant to the addressee) are fundamental to psychopathology. In this paper, we consider the implications of this hypothesis for understanding the role of aggression in conduct disorder and conduct problems more generally. Our main proposal is to view conduct problems not only as reflecting dysregulation, but as an adaptation that allows communication with others who are (or are perceived to be) unreliable. Our formulation hinges on two propositions. The first one is to view aggression as a modality of communication adapted to scenarios in which the communicator expects the audience to have low epistemic trust in the communicator. The second idea is to conceptualize the failed "unlearning of aggression" as reflecting a lack of interest in maintaining one's reputation as a communicator, which in turn stems from a lack of epistemic trust in other communicators. In this paper, we discuss these ideas and examine how they may account for the developmental pathways that lead young people to develop conduct problems.
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Affiliation(s)
- Alessandro Talia
- Institute for Psychosocial Prevention, University of Heidelberg, Heidelberg, Germany
| | - Robbie Duschinsky
- Primary Care Unit, University of Cambridge, Cambridge, United Kingdom
| | - Diana Mazzarella
- Cognitive Science Centre of the University of Neuchâtel, Neuchâtel, Switzerland
| | - Sophie Hauschild
- Institute for Psychosocial Prevention, University of Heidelberg, Heidelberg, Germany
| | - Svenja Taubner
- Institute for Psychosocial Prevention, University of Heidelberg, Heidelberg, Germany
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McKinney C, Stearns M, Szkody E. Temperament and Affective and Behavioral ODD Problems in Emerging Adults: Moderation by Gender and Perceived Parental Psychopathology. Child Psychiatry Hum Dev 2020; 51:900-912. [PMID: 32048113 DOI: 10.1007/s10578-020-00969-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Recent research has indicated that ODD problems persist into emerging adulthood, although mechanisms influencing ODD during emerging adulthood remain relatively unknown. Additionally, temperament and parental psychopathology both are implicated in the development of childhood ODD. Thus, the current study examined how perceived parental (i.e., maternal and paternal) psychopathology (i.e., anxiety, depressive, and antisocial problems) moderated the relationship between temperament (i.e., effortful control, negative affect, and surgency) and ODD problems (i.e., affective and behavioral) in a sample of 599 emerging adults who were instructed to complete questionnaires based on their current perceptions. Results indicated that perceived parental anxiety and antisocial problems moderated the relationship between two of the temperament variables (i.e., negative affect and effortful control) and both types of ODD problems. Moreover, these results were further moderated by participant gender. Finally, perceived parental depressive problems served as a moderator for affective problems only. Overall, results suggest that similar associations found regarding childhood ODD may be implicated when examining emerging adults, and gender moderates these associations.
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Affiliation(s)
| | | | - Erica Szkody
- Mississippi State University, Starkville, MS, USA
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29
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Richard J, Fletcher É, Boutin S, Derevensky J, Temcheff C. Conduct problems and depressive symptoms in association with problem gambling and gaming: A systematic review. J Behav Addict 2020; 9:497-533. [PMID: 32750033 PMCID: PMC8943658 DOI: 10.1556/2006.2020.00045] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/21/2020] [Accepted: 06/26/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND AND AIMS Behavioral addictions such as gambling and gaming disorder are significant public health issues that are of increasing importance to policy makers and health care providers. Problem gambling and gaming behaviors have been identified as being associated with externalizing and internalizing problems, with theoretical models suggesting that both conduct problems and depressive symptoms may be significant risk factors in the development of problem gambling and gaming. As such, the purpose of this systematic review is to provide an overview of research identifying the relationship between conduct problems, depressive symptoms and problem gambling and gaming among adolescents and young adults. METHODS Systematic literature searches in accordance with PRISMA guidelines found 71 eligible studies that met the inclusion criteria, 47 for problem gambling, 23 for problem gaming and one for both problem behaviors. RESULTS Based on cross-sectional evidence, both problem gambling and gaming are consistently concurrently associated with conduct problems and depressive symptoms. Longitudinal evidence appears to be clearer for conduct problems as a risk factor for problem gambling, and depressive symptoms as a risk factor for problem gaming. However, both risk factors appear to increase the risk for these problem behaviors. DISCUSSION AND CONCLUSIONS Results from the literature review suggest that problem gambling and gaming are associated with the presence of conduct problems and depressive symptoms, with the potential of sharing common etiological factors. Additional research is necessary to confirm these longitudinal relationships with an emphasis on investigating the interaction of both early conduct problems and depressive symptoms.
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Affiliation(s)
- Jérémie Richard
- International Centre for Youth Gambling Problems and High-Risk Behaviors, McGill University, Montreal, QC, Canada,Department of Educational and Counselling Psychology, Faculty of Education, McGill University, Montreal, QC, Canada,Corresponding author. E-mail:
| | - Émilie Fletcher
- International Centre for Youth Gambling Problems and High-Risk Behaviors, McGill University, Montreal, QC, Canada,Department of Educational and Counselling Psychology, Faculty of Education, McGill University, Montreal, QC, Canada
| | - Stephanie Boutin
- International Centre for Youth Gambling Problems and High-Risk Behaviors, McGill University, Montreal, QC, Canada,Department of Educational and Counselling Psychology, Faculty of Education, McGill University, Montreal, QC, Canada
| | - Jeffrey Derevensky
- International Centre for Youth Gambling Problems and High-Risk Behaviors, McGill University, Montreal, QC, Canada,Department of Educational and Counselling Psychology, Faculty of Education, McGill University, Montreal, QC, Canada
| | - Caroline Temcheff
- International Centre for Youth Gambling Problems and High-Risk Behaviors, McGill University, Montreal, QC, Canada,Department of Educational and Counselling Psychology, Faculty of Education, McGill University, Montreal, QC, Canada
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30
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de la Peña IC, Pan MC, Thai CG, Alisso T. Attention-Deficit/Hyperactivity Disorder Predominantly Inattentive Subtype/Presentation: Research Progress and Translational Studies. Brain Sci 2020; 10:brainsci10050292. [PMID: 32422912 PMCID: PMC7287898 DOI: 10.3390/brainsci10050292] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/08/2020] [Accepted: 05/09/2020] [Indexed: 02/01/2023] Open
Abstract
Research on the predominantly inattentive attention-deficit/hyperactivity disorder (ADHD-PI) subtype/presentation is important given its high prevalence, but paradoxically it is under-recognized and undertreated. The temporal stability of the inattention symptom could impact the high worldwide prevalence of ADHD-PI. Some evidence suggests differences in the nature of attentional deficit in ADHD-PI vs. that in other subtypes. Impairments in neuropsychological, neurocognitive, and social functioning are also evident in ADHD-PI, which could be specific to the subtype (e.g., processing speed, social perception, and skills), or differ from others in severity. Neuroimaging studies have also revealed ADHD-PI-specific neuropathological abnormalities and those that are shared with other subtypes. ADHD-PI is highly comorbid with learning and internalizing (e.g., anxiety and depression) disorders. There is no solid evidence for ADHD-PI-specific genetic etiologies and differential responses of subtypes to ADHD medications. Translational studies have used the Wistar Kyoto/NCrl substrain which requires further characterizations as an ADHD-PI model. Overall, ADHD-PI research has been conducted in the context of the Diagnostic and Statistical Manual, which arguably does not conform to the widely recognized "dimensional" view of ADHD. The Research Domain Criteria has been proposed to provide a novel framework for understanding the nature of neuropsychiatric illnesses and ultimately improve their diagnosis and treatment.
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Affiliation(s)
- Ike C. de la Peña
- Department of Pharmaceutical and Administrative Sciences, Loma Linda University School of Pharmacy, Loma Linda, CA 92350, USA; (C.G.T.); (T.A.)
- Correspondence: ; Tel.: +1-909-651-5995; Fax: +1-909-558-0446
| | - Michael C. Pan
- Department of Psychology, Korea University, Seoul 02841, Korea;
- Division of Social Sciences, University of the Philippines Visayas Tacloban College, Tacloban 6500, Philippines
| | - Chau Giang Thai
- Department of Pharmaceutical and Administrative Sciences, Loma Linda University School of Pharmacy, Loma Linda, CA 92350, USA; (C.G.T.); (T.A.)
| | - Tamara Alisso
- Department of Pharmaceutical and Administrative Sciences, Loma Linda University School of Pharmacy, Loma Linda, CA 92350, USA; (C.G.T.); (T.A.)
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Luyten P, Campbell C, Allison E, Fonagy P. The Mentalizing Approach to Psychopathology: State of the Art and Future Directions. Annu Rev Clin Psychol 2020; 16:297-325. [DOI: 10.1146/annurev-clinpsy-071919-015355] [Citation(s) in RCA: 162] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Mentalizing is the capacity to understand others and oneself in terms of internal mental states. It is assumed to be underpinned by four dimensions: automatic–controlled, internally–externally focused, self–other, and cognitive–affective. Research suggests that mental disorders are associated with different imbalances in these dimensions. Addressing the quality of mentalizing as part of psychosocial treatments may benefit individuals with various mental disorders. We suggest that mentalizing is a helpful transtheoretical and transdiagnostic concept to explain vulnerability to psychopathology and its treatment. This review summarizes the mentalizing approach to psychopathology from a developmental socioecological evolutionary perspective. We then focus on the application of the mentalizing approach to personality disorders, and we review studies that have extended this approach to other types of psychopathology, including depression, anxiety, and eating disorders. We summarize core principles of mentalization-based treatments and preventive interventions and the evidence for their effectiveness. We conclude with recommendations for future research.
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Affiliation(s)
- Patrick Luyten
- Faculty of Psychology and Educational Sciences, KU Leuven, B-3000 Leuven, Belgium
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 7HB, United Kingdom
| | - Chloe Campbell
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 7HB, United Kingdom
| | - Elizabeth Allison
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 7HB, United Kingdom
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 7HB, United Kingdom
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32
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Burley DT, van Goozen SHM. Pupil Response to Affective Stimuli: a Biomarker of Early Conduct Problems in Young Children. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 48:693-701. [PMID: 31982978 PMCID: PMC7188718 DOI: 10.1007/s10802-020-00620-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
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.
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Affiliation(s)
- Daniel T Burley
- School of Psychology, Cardiff University, Cardiff, CF10 3AT, UK.
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Morosan L, Ghisletta P, Badoud D, Toffel E, Eliez S, Debbané M. Longitudinal Relationships Between Reflective Functioning, Empathy, and Externalizing Behaviors During Adolescence and Young Adulthood. Child Psychiatry Hum Dev 2020; 51:59-70. [PMID: 31309356 DOI: 10.1007/s10578-019-00910-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Reflective functioning (RF) refers to the understanding of one's own and others' behaviors in terms of mental states, whereas empathy entails the abilities to understand (cognitive empathy) and to share (affective empathy) the emotions of others. Low RF and low empathy have been previously related to externalizing behaviors, such as aggression and rule breaking. However, few longitudinal studies have simultaneously examined the relationships between these variables during adolescence. The aim of the present study is to investigate the longitudinal effects of both RF and empathy on potential changes in externalizing behaviors over time, in a group of 103 adolescents and young adults from the general population assessed repeatedly up to four times. We conducted multilevel analysis in order to examine the effects of RF and empathy on the initial levels and the trajectories of externalizing behaviors over time, while accounting for other variables previously associated with externalizing behaviors, such as age, gender, internalizing problems, and cognitive abilities. The results suggest that the ability to reflect on behaviors in terms of mental states predicted a sharper decrease in externalizing behaviors over time. Moreover, externalizing behaviors at the first assessment were associated with RF impairments and low affective empathy. Age, gender, cognitive abilities, and cognitive empathy were not associated with externalizing behaviors. We discuss how our results, based on a typically developing population, might inform primary or indicated prevention strategies for externalizing behaviors by focusing on socio-cognitive processes such as RF and affective empathy.
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Affiliation(s)
- Larisa Morosan
- Faculty of Psychology and Educational Sciences, University of Geneva, 40, Bd du Pont-d'Arve, 1211, Geneva, Switzerland. .,Developmental Imaging and Psychopathology Lab, University of Geneva, Geneva, Switzerland.
| | - Paolo Ghisletta
- Faculty of Psychology and Educational Sciences, University of Geneva, 40, Bd du Pont-d'Arve, 1211, Geneva, Switzerland.,Faculty of Psychology, Swiss Distance Learning University, Brig, Switzerland.,Swiss National Center of Competences in Research LIVES-Overcoming Vulnerability: Life Course Perspectives-University of Geneva, Geneva, Switzerland
| | - Deborah Badoud
- Faculty of Psychology and Educational Sciences, University of Geneva, 40, Bd du Pont-d'Arve, 1211, Geneva, Switzerland.,Developmental Imaging and Psychopathology Lab, University of Geneva, Geneva, Switzerland
| | - Elodie Toffel
- Faculty of Psychology and Educational Sciences, University of Geneva, 40, Bd du Pont-d'Arve, 1211, Geneva, Switzerland.,Developmental Imaging and Psychopathology Lab, University of Geneva, Geneva, Switzerland
| | - Stephan Eliez
- Developmental Imaging and Psychopathology Lab, University of Geneva, Geneva, Switzerland
| | - Martin Debbané
- Faculty of Psychology and Educational Sciences, University of Geneva, 40, Bd du Pont-d'Arve, 1211, Geneva, Switzerland.,Developmental Imaging and Psychopathology Lab, University of Geneva, Geneva, Switzerland.,Research Department of Clinical, Educational, and Health Psychology, University College London, London, UK
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The validity of conduct disorder symptom profiles in high-risk male youth. Eur Child Adolesc Psychiatry 2019; 28:1537-1546. [PMID: 31004293 DOI: 10.1007/s00787-019-01339-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 04/15/2019] [Indexed: 01/03/2023]
Abstract
Conduct disorder (CD) is a heterogeneous pattern of rule-breaking and aggressive symptoms. Until now it has been unclear whether valid, clinically useful symptom profiles can be defined for populations in youth at high-risk of CD. Interview-based psychiatric disorders, CD symptoms and officially recorded offences were assessed in boys from a detention facility and a forensic psychiatric hospital (N = 281; age 11.2-21.3 years). We used latent class analyses (LCA) to examine CD subtypes and their relationships with comorbid psychiatric disorders, suicidality, and criminal recidivism. LCA revealed five CD subtypes: no CD, mild aggressive CD, mild covert CD, moderate CD, and severe CD. The severe and, to a lesser degree, the moderate CD subtype were related to comorbid attention deficit hyperactivity disorder, substance use disorder, affective disorder, and suicidality. Time to violent criminal re-offending was predicted by severe CD (OR 5.98, CI 2.5-13.80) and moderate CD (OR 4.18, CI 1.89-9.21), but not by any other CD subtype in multivariate Cox regressions (controlling for age, low socioeconomic status and foreign nationality). These results confirm the existence of different CD symptom profiles in a high-risk group. Additional variable-oriented analyses with CD symptom count and aggressive/rule-breaking CD-dimensions further supported a dimensional view and a dose-response relationship of CD and criminal recidivism. Classifying high-risk young people according to the number of aggressive and rule-breaking CD symptoms is of major clinical importance and may provide information about risk of violent recidivism.
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Attention-deficit/hyperactivity disorder: An integrated developmental psychopathology and Research Domain Criteria (RDoC) approach. Compr Psychiatry 2019; 90:65-72. [PMID: 30743139 PMCID: PMC6913174 DOI: 10.1016/j.comppsych.2018.12.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 12/22/2018] [Accepted: 12/24/2018] [Indexed: 12/12/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is characterized by heterogeneous behaviors and symptoms, developmental trajectories, and treatment response. Isolating intermediate phenotypes that are superior to current DSM-based nosology in order to explain such heterogeneity is integral to enhancing etiological theory, improving clinical assessment, predicting treatment response, and developing tailored treatments. To this end, this review provides an integrated developmental psychopathology and National Institute of Mental Health Research Domain Criteria (RDoC) approach to ADHD. In particular, associations between ADHD and RDoC domains of cognition (specifically working memory) and positive valence (reward anticipation/delay/receipt) are discussed. These domains are examined across behavioral and neurocircuitry levels of analysis and placed within a developmental context via examining associations among RDoC domains, relevant features of ADHD, and environmental correlates implicated across development. Limitations of the existing literature and proposed future directions are explored. Importantly, future work should focus on novel approaches that account for developmental shifts in functioning of relevant RDoC domains over time, as well as further examination of the interaction across RDoC domains and levels of analysis.
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Jewell T, Gardner T, Susi K, Watchorn K, Coopey E, Simic M, Fonagy P, Eisler I. Attachment measures in middle childhood and adolescence: A systematic review of measurement properties. Clin Psychol Rev 2019; 68:71-82. [DOI: 10.1016/j.cpr.2018.12.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 12/03/2018] [Accepted: 12/31/2018] [Indexed: 10/27/2022]
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Maternal ratings of ODD symptoms: Subtypes versus severity in a general community sample of children. Compr Psychiatry 2018; 81:81-90. [PMID: 29306067 DOI: 10.1016/j.comppsych.2017.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 11/27/2017] [Accepted: 12/05/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND AND AIMS Oppositional Defiant Disorder (ODD) is a common childhood disorder (American Psychiatric Association [APA], 2000; APA, 2013). The aim of the present study was to ascertain the optimal structure for the ODD symptoms by identifying whether ODD is a qualitatively distinct entity (categorical) or is a continuum, with high levels on this continuum reflecting ODD (quantitative or dimensional view). METHODS Mothers' ratings of the ODD symptoms of 457 children, aged 3 to 15years, as presented in the disruptive behavior rating scale were obtained. Confirmatory factor analysis (CFA), latent class analysis (LCA), and factor mixture modelling (FMM) were applied to determine the best model for oppositional defiant disorder (ODD) symptoms in children. RESULTS The findings provided most support for a FMM with 3 classes (unaffected odd class, at risk class, and affected class) and 3 factors (oppositional, antagonistic, and negative affect). CONCLUSION The findings are discussed in relation to dimensional, categorical, and hybrid (categorical/dimensional) models of ODD symptoms.
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The aetiology of borderline personality disorder (BPD): contemporary theories and putative mechanisms. Curr Opin Psychol 2017; 21:105-110. [PMID: 29182951 DOI: 10.1016/j.copsyc.2017.10.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 10/27/2017] [Accepted: 10/31/2017] [Indexed: 12/11/2022]
Abstract
This article presents an overview of current knowledge regarding the aetiology of Borderline Personality Disorder (BPD). It begins with a brief synopsis of early research and theory, and discusses how changing conceptualisations of BPD have impacted on our aetiological knowledge. Contemporary theories are described and presented within a developmental psychopathology framework. Deficient co-regulation and social communication in infancy are purported to underpin emotional dysregulation and social cognition deficits across development. These mechanisms are further potentiated by maladaptive social experiences in a series of positive feedback loops. Prospective research provides preliminary evidence for the reciprocal (or mediating) effects of maladaptive experiences and childhood dysregulation. Moving forward, cohort studies may incorporate neurobiological assessments to examine the biological systems underpinning phenotypic (e.g., impulsivity, disturbed relatedness) covariation.
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