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Winters DE, Sakai JT. Affective theory of mind impairments underlying callous-unemotional traits and the role of cognitive control. Cogn Emot 2023; 37:696-713. [PMID: 37017241 PMCID: PMC10330116 DOI: 10.1080/02699931.2023.2195154] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/14/2023] [Accepted: 03/21/2023] [Indexed: 04/06/2023]
Abstract
Affective theory of mind (aToM) impairments associated with the youth antisocial phenotype callous-unemotional (CU) traits predict antisocial behaviour above CU traits alone. Importantly, CU traits associate with decrements in complex but not basic aToM. aToM is modulated by cognitive control and CU traits associate with cognitive control impairments; thus, cognitive control is a plausible mechanism underlying aToM impairments in CU traits. Because cognitive control is dependent on the availability of cognitive resources, youth with CU traits may have difficulty with allocating cognitive resources under greater demands that impact complex aToM. To test this, 81 participants (ages 12-14, Female = 51.8%, Male = 48.2%) were recruited to complete a behavioural paradigm that involved an initial aToM task with complex and basic emotions followed by placing additional demands on cognitive control and a final repeat of the same aToM task. Results indicate adolescents higher in CU traits had intact basic aToM but less accuracy in complex aToM that worsened after taxing cognitive control; and this load only required a short duration to account for ToM decrements (200 ms [range 150-1600 ms]). These results demonstrate CU traits association with cognitive control limitations that impact complex aToM. This may partially explain antisocial behaviour associated with CU traits.
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Affiliation(s)
- Drew E Winters
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Joseph T Sakai
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
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Salekin RT. Some critical comments on the paper titled "Some critical considerations in applying the construct of psychopathy to research and classification of childhood disruptive behavior disorders". Clin Psychol Rev 2022; 98:102214. [PMID: 36328895 DOI: 10.1016/j.cpr.2022.102214] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Frick (2022) presented a narrative review of some literature and made several critical comments regarding the extension of the full psychopathy construct to research and classification of childhood disruptive behavior disorders (DBDs). His arguments cautioned against the use of the multicomponent concept of psychopathy for specification of DBDs for several reasons including definitional issues, symptom sequencing, specifier versus risk factor considerations, potential overlap with other disorders and criteria (e.g., ADHD), and concerns regarding harm. While I agree with Frick (2022) that we need to be cautious when extending personality constructs to the DBDs, the remaining arguments in his paper fall short of calling for the exclusion of psychopathy components in the examination of DBDs. Rather, the counterpoints in this paper further convince that the multidimensional model of psychopathy, when applied to the DBDs, could better facilitate understanding of the etiology and mechanisms for Conduct Disorder (CD), and, it may help us to predict the prognosis and treatment outcomes of children with various forms of DBDs such as CD and Oppositional Defiant Disorder (ODD). To have the most informative designs, future research should examine the broad construct to glean a better understanding of psychopathy and the DBDs. Further, research should continue to examine sequencing and external correlates at the component level and to test the incremental value of the multicomponent model of psychopathy to help us better comprehend how each component may facilitate our understanding of the types and severity of conduct problems exhibited by youth with DBDs (i.e., CD, ODD).
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Colins OF, Van Damme L, Hendriks AM, Georgiou G. The DSM-5 with Limited Prosocial Emotions Specifier for Conduct Disorder: a Systematic Literature Review. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2020. [DOI: 10.1007/s10862-020-09799-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AbstractDSM-5 added a categorically defined specifier (‘with Limited Prosocial Emotions’; LPE) for the diagnosis of conduct disorder (CD). This paper systematically reviews the evidence base for this specifier in children and adolescents who are diagnosed with CD. Computer-assisted searches were executed and identified 181 potentially relevant papers. Eventually, nine papers were included in this review, referring to eight unique samples. All studies constructed an LPE measure by pulling the same items from the same rating scales that were used in the development of the DSM-5 LPE specifier. The prevalence of youth with CD who met criteria for this novel LPE specifier (CD + LPE) ranged from 6.1% to 83.7%. The studies greatly varied in the features used to test the viability of the DSM-5 LPE specifier. The most commonly used features relate to severity of antisocial behavior, low neuroticism (or lack of anxiety and depression), and treatment responsiveness. Available work altogether showed that CD + LPE youth displayed higher levels of past antisocial behaviour than CD Only youth, but failed to reveal other group differences that corroborate with expectations. Effect sizes typically were in the small to moderate range, suggesting that the practical usefulness of the group differences is limited. Empirical work shows that this specifier should not be used for clinical decision-making when relying on items from measures that have been used in the development of the LPE specifier. Crucially, limitations that hallmark the few studies on the topic hamper any firm conclusion about the usefulness of the specifier.
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Herpers PCM, Klip H, Rommelse NNJ, Taylor MJ, Greven CU, Buitelaar JK. Taxometric analyses and predictive accuracy of callous-unemotional traits regarding quality of life and behavior problems in non-conduct disorder diagnoses. Psychiatry Res 2017; 253:351-359. [PMID: 28427034 DOI: 10.1016/j.psychres.2017.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 03/19/2017] [Accepted: 04/02/2017] [Indexed: 11/18/2022]
Abstract
Callous-unemotional (CU) traits have mainly been studied in relation to conduct disorder (CD), but can also occur in other disorder groups. However, it is unclear whether there is a clinically relevant cut-off value of levels of CU traits in predicting reduced quality of life (QoL) and clinical symptoms, and whether CU traits better fit a categorical (taxonic) or dimensional model. Parents of 979 youths referred to a child and adolescent psychiatric clinic rated their child's CU traits on the Inventory of Callous-Unemotional traits (ICU), QoL on the Kidscreen-27, and clinical symptoms on the Child Behavior Checklist. Experienced clinicians conferred DSM-IV-TR diagnoses of ADHD, ASD, anxiety/mood disorders and DBD-NOS/ODD. The ICU was also used to score the DSM-5 specifier 'with limited prosocial emotions' (LPE) of Conduct Disorder. Receiver operating characteristic (ROC) analyses revealed that the predictive accuracy of the ICU and LPE regarding QoL and clinical symptoms was poor to fair, and similar across diagnoses. A clinical cut-off point could not be defined. Taxometric analyses suggested that callous-unemotional traits on the ICU best reflect a dimension rather than taxon. More research is needed on the impact of CU traits on the functional adaptation, course, and response to treatment of non-CD conditions.
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Affiliation(s)
- Pierre C M Herpers
- Karakter, Child and Adolescent Psychiatry, University Center, Reinier Postlaan 12, 6525 GC Nijmegen, The Netherlands; Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Psychiatry, Kapittelweg 29, 6525 EN Nijmegen, The Netherlands.
| | - Helen Klip
- Karakter, Child and Adolescent Psychiatry, University Center, Reinier Postlaan 12, 6525 GC Nijmegen, The Netherlands
| | - Nanda N J Rommelse
- Karakter, Child and Adolescent Psychiatry, University Center, Reinier Postlaan 12, 6525 GC Nijmegen, The Netherlands; Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Psychiatry, Kapittelweg 29, 6525 EN Nijmegen, The Netherlands
| | - Mark J Taylor
- Karolinska Institutet, Department of Medical Epidemiology & Biostatistics, Nobels väg 12A, Stockholm 17177, Sweden
| | - Corina U Greven
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Kapittelweg 29, 6525 EN Nijmegen, The Netherlands; King's College London, Medical Research Council Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London SE5 8AF, United Kingdom
| | - Jan K Buitelaar
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Kapittelweg 29, 6525 EN Nijmegen, The Netherlands
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Sakai JT, Dalwani MS, Mikulich-Gilbertson SK, Raymond K, McWilliams S, Tanabe J, Rojas D, Regner M, Banich MT, Crowley TJ. Imaging decision about whether to benefit self by harming others: Adolescents with conduct and substance problems, with or without callous-unemotionality, or developing typically. Psychiatry Res 2017; 263:103-112. [PMID: 28371655 PMCID: PMC5705947 DOI: 10.1016/j.pscychresns.2017.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 01/26/2017] [Accepted: 03/08/2017] [Indexed: 01/12/2023]
Abstract
We sought to identify brain activation differences in conduct-problem youth with limited prosocial emotions (LPE) compared to conduct-problem youth without LPE and community adolescents, and to test associations between brain activation and severity of callous-unemotional traits. We utilized a novel task, which asks subjects to repeatedly decide whether to accept offers where they will benefit but a beneficent other will be harmed. Behavior on this task has been previously associated with levels of prosocial emotions and severity of callous-unemotional traits, and is related to empathic concern. During fMRI acquisition, 66 male adolescents (21 conduct-problem patients with LPE, 21 without, and 24 typically-developing controls) played this novel game. Within typically-developing controls, we identified a network engaged during decision involving bilateral insula, and inferior parietal and medial frontal cortices, among other regions. Group comparisons using non-parametric (distribution-free) permutation tests demonstrated LPE patients had lower activation estimates than typically-developing adolescents in right anterior insula. Additional significant group differences emerged with our a priori parametric cluster-wise inference threshold. These results suggest measurable functional brain activation differences in conduct-problem adolescents with LPE compared to typically-developing adolescents. Such differences may underscore differential treatment needs for conduct-problem males with and without LPE.
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Affiliation(s)
- Joseph T Sakai
- University of Colorado, School of Medicine, Department of Psychiatry, Aurora, CO, USA.
| | - Manish S Dalwani
- University of Colorado, School of Medicine, Department of Psychiatry, Aurora, CO, USA
| | | | - Kristen Raymond
- University of Colorado, School of Medicine, Department of Psychiatry, Aurora, CO, USA
| | - Shannon McWilliams
- University of Colorado, School of Medicine, Department of Psychiatry, Aurora, CO, USA
| | - Jody Tanabe
- University of Colorado, School of Medicine, Department of Radiology, Aurora, CO, USA
| | - Don Rojas
- Colorado State University, Fort Collins, CO, USA
| | - Michael Regner
- University of Colorado, School of Medicine, Department of Radiology, Aurora, CO, USA
| | - Marie T Banich
- University of Colorado Boulder, Institute of Cognitive Science, Boulder, CO, USA
| | - Thomas J Crowley
- University of Colorado, School of Medicine, Department of Psychiatry, Aurora, CO, USA
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