Does comorbid anxiety counteract emotion recognition deficits in conduct disorder?

The role of anxiety and callous-unemotional traits in the relationship between externalizing behaviors and sleep problems in clinic-referred youth

In a growing body of literature, poor sleep quality has been associated with externalizing problems. In adults, anxiety was found to mediate the relationship, and callous-unemotional (CU) traits were found to moderate it. We sought to examine these relationships in a child population. We examined these relationships in 239 clinic-referred youth (age 6-17) in Singapore with externalizing behavior problems. Parent- but not child-rated sleep problems were associated with increased parent-rated externalizing problems. This association was partially mediated by anxiety. Unlike in adults, CU traits did not moderate the relationship. Sleep problems were associated with externalizing problems regardless of the level of CU traits. It is possible externalizing behaviors may lead children to internalize experiences, leading to anxiety about their behaviors. Another possibility is externalizing behaviors may lead to more stressful life experiences due to negative reactions children with externalizing behaviors receive from parents, teachers, or peers. Regardless, the partial mediation found indicates anxiety may be an important factor to consider in future interventions focused on improving sleep as a means to reduce externalizing problems.

Characterizing Youth-Caregiver Concordance and Discrepancies in Psychopathology Symptoms in a US Community Sample

Evidence shows that reports of psychopathology symptoms by youth and their caregiver informants differ. To quantify youth-caregiver discrepancies in psychopathology symptoms and factors associated with such discrepancies, we investigated differences in how youth and their caregivers rated psychopathology symptoms. The sample (N = 5094) was extracted from the Philadelphia Neurodevelopmental Cohort, a community-based sample of youth and included participants ages 11-17 years old with both youth and caregiver reported symptom scores. Across psychopathology symptoms, youth-caregiver concordance was poor to fair (Cohens kappa for symptom items ranged between 0.03-0.41). Psychosis symptoms had the lowest concordance-Cohen's kappa ranged from 0.03 to 0.17 across psychosis symptoms. Discrepancies between youth and caregiver symptom reports were greater than average for Black youth and for youth of low socioeconomic status; discrepancies were also higher than average in youth with any psychiatric disorder when compared to typically developing youth. Network analysis of difference scores obtained by subtracting youth symptom scores from caregiver reported symptom scores showed that network connectivity (i.e., correlated difference scores) was sparsest for psychosis spectrum compared to other psychiatric disorders. Using a large sample, we show that youth and their caregiver informants tend to report psychopathology symptoms differently. Youth-caregiver discrepancies were the most pronounced for Black youth and youth of low socio-economic status. Race and socioeconomic status contribute to significant differences in how youth and their caregivers report such symptoms and are important factors that should be accounted for to facilitate accurate mental health symptom assessment and evaluation.

The Differential Effect of Anxiety and ADHD Symptoms on Inhibitory Control and Sustained Attention for Threat Stimuli: A Go/No-Go Eye-Movement Study

Objective: This study examined the synergistic effects of ADHD and anxiety symptoms on attention and inhibitory control depending on the emotional content of the stimuli. Method: Fifty-four typically developing individuals (27 children/adolescents and 27 adults) completed an eye-movement based emotional Go/No-Go task, using centrally presented (happy, angry) faces and neutral/symbolic stimuli. Sustained attention was measured through saccade latencies and saccadic omission errors (Go trials), and inhibitory control through saccadic commission errors (No-Go trials). ADHD and anxiety were assessed dimensionally. Results: Elevated ADHD symptoms were associated with more commission errors and slower saccade latencies for angry (vs. happy) faces. In contrast, angry faces were linked to faster saccade onsets when anxiety symptoms were high, and this effect prevailed when both anxiety and ADHD symptoms were high. Conclusion: Social threat impacted performance in individuals with sub-clinical anxiety and ADHD differently. The effects of anxiety on threat processing prevailed when both symptoms were high.

Machine learning classification of conduct disorder with high versus low levels of callous-unemotional traits based on facial emotion recognition abilities

Conduct disorder (CD) with high levels of callous-unemotional traits (CD/HCU) has been theoretically linked to specific difficulties with fear and sadness recognition, in contrast to CD with low levels of callous-unemotional traits (CD/LCU). However, experimental evidence for this distinction is mixed, and it is unclear whether these difficulties are a reliable marker of CD/HCU compared to CD/LCU. In a large sample (N = 1263, 9-18 years), we combined univariate analyses and machine learning classifiers to investigate whether CD/HCU is associated with disproportionate difficulties with fear and sadness recognition over other emotions, and whether such difficulties are a reliable individual-level marker of CD/HCU. We observed similar emotion recognition abilities in CD/HCU and CD/LCU. The CD/HCU group underperformed relative to typically developing (TD) youths, but difficulties were not specific to fear or sadness. Classifiers did not distinguish between youths with CD/HCU versus CD/LCU (52% accuracy), although youths with CD/HCU and CD/LCU were reliably distinguished from TD youths (64% and 60%, respectively). In the subset of classifiers that performed well for youths with CD/HCU, fear and sadness were the most relevant emotions for distinguishing them from youths with CD/LCU and TD youths, respectively. We conclude that non-specific emotion recognition difficulties are common in CD/HCU, but are not reliable individual-level markers of CD/HCU versus CD/LCU. These findings highlight that a reduced ability to recognise facial expressions of distress should not be assumed to be a core feature of CD/HCU.

Pediatric anxiety associated with altered facial emotion recognition

Multiple psychiatric disorders are associated with difficulties in facial emotion recognition. However, generalized anxiety disorder may be associated with more accurate recognition of others' emotional expressions, particularly expressions of happiness and fear, which index safety and threat. Children aged 9-14 from a community sample (N = 601) completed a facial emotion labeling task. Children's symptoms of depressive and anxiety syndromes were assessed by self- and parent-report. Elevated symptoms of generalized anxiety disorder were associated with more accurate facial emotion recognition (β = 0.16, p = 0.007), specifically recognition of happiness (β = 0.17, p = 0.002) and fear (β = 0.15, p = 0.006). Elevated depressive symptoms were associated with less accurate facial emotion recognition (β = -0.12, p = 0.018), specifically happiness (β = -0.15, p = 0.002). Elevated symptoms of separation anxiety disorder were also associated with less accurate facial emotion recognition (β = -0.16, p = 0.003), specifically happiness (β = -0.15, p = 0.006) and fear (β = -0.15, p = 0.005), which highlights the importance of distinguishing between anxiety syndromes. Results held when adjusting for child age and sex. Evidence that symptoms of generalized anxiety disorder are associated with more accurate recognition of happiness and fear is consistent with theories of heightened social vigilance and support a transdiagnostic role of facial emotion recognition that may inform the psychosocial development of youth with anxiety and depressive symptoms.

Investigating Emotional Body Posture Recognition in Adolescents with Conduct Disorder Using Eye-Tracking Methods

Adolescents with Conduct Disorder (CD) show deficits in recognizing facial expressions of emotion, but it is not known whether these difficulties extend to other social cues, such as emotional body postures. Moreover, in the absence of eye-tracking data, it is not known whether such deficits, if present, are due to a failure to attend to emotionally informative regions of the body. Male and female adolescents with CD and varying levels of callous-unemotional (CU) traits (n = 45) and age- and sex-matched typically-developing controls (n = 51) categorized static and dynamic emotional body postures. The emotion categorization task was paired with eye-tracking methods to investigate relationships between fixation behavior and recognition performance. Having CD was associated with impaired recognition of static and dynamic body postures and atypical fixation behavior. Furthermore, males were less likely to fixate emotionally-informative regions of the body than females. While we found no effects of CU traits on body posture recognition, the effects of CU traits on fixation behavior varied according to CD status and sex, with CD males with lower levels of CU traits showing the most atypical fixation behavior. Critically, atypical fixation behavior did not explain the body posture recognition deficits observed in CD. Our findings suggest that CD-related impairments in recognition of body postures of emotion are not due to attentional issues. Training programmes designed to ameliorate the emotion recognition difficulties associated with CD may need to incorporate a body posture component.

In the eyes of the beholder: investigating the effect of visual probing on accuracy and gaze fixations when attending to facial expressions among primary and secondary callous-unemotional variants

Individuals with callous-unemotional (CU) traits show deficits in facial emotion recognition. According to preliminary research, this impairment may be due to attentional neglect to peoples' eyes when evaluating emotionally expressive faces. However, it is unknown whether this atypical processing pattern is unique to established variants of CU traits or modifiable with intervention. This study examined facial affect recognition and gaze patterns among individuals (N = 80; M age = 19.95, SD = 1.01 years; 50% female) with primary vs secondary CU variants. These groups were identified based on repeated measurements of conduct problems, CU traits, and anxiety assessed in adolescence and adulthood. Accuracy and number of fixations on areas of interest (forehead, eyes, and mouth) while viewing six dynamic emotions were assessed. A visual probe was used to direct attention to various parts of the face. Individuals with primary and secondary CU traits were less accurate than controls in recognizing facial expressions across all emotions. Those identified in the low-anxious primary-CU group showed reduced overall fixations to fearful and painful facial expressions compared to those in the high-anxious secondary-CU group. This difference was not specific to a region of the face (i.e. eyes or mouth). Findings point to the importance of investigating both accuracy and eye gaze fixations, since individuals in the primary and secondary groups were only differentiated in the way they attended to specific facial expression. These findings have implications for differentiated interventions focused on improving facial emotion recognition with regard to attending and correctly identifying emotions.

Executive functioning and emotion recognition in youth with oppositional defiant disorder and/or conduct disorder

Objectives: Executive functioning and emotion recognition may be impaired in disruptive youth, yet findings in oppositional defiant disorder (ODD) and conduct disorder (CD) are inconsistent. We examined these functions related to ODD and CD, accounting for comorbid attention-deficit/hyperactivity disorder (ADHD) and internalising symptoms.Methods: We compared executive functioning (visual working memory, visual attention, inhibitory control) and emotion recognition between youth (8-18 years old, 123 boys, 55 girls) with ODD (n = 44) or CD (with/without ODD, n = 48), and healthy controls (n = 86). We also related ODD, CD, and ADHD symptom counts and internalising symptomatology to all outcome measures, as well as executive functioning to emotion recognition.Results: Visual working memory and inhibitory control were impaired in the ODD and CD groups versus healthy controls. Anger, disgust, fear, happiness, and sadness recognition were impaired in the CD group; only anger recognition was impaired in the ODD group. Deficits were not explained by comorbid ADHD or internalising symptoms. Visual working memory was associated with recognition of all basic emotions.Conclusions: Our findings challenge the view that neuropsychological impairments in youth with ODD/CD are driven by comorbid ADHD and suggest possible distinct neurocognitive mechanisms in CD versus ODD.

Psychopathic traits are associated with reduced fixations to the eye region of fearful faces

Impairments in processing fearful faces have been documented in both children and adults with psychopathic traits, suggesting a potential mechanism by which psychopathic individuals develop callous and manipulative interpersonal and affective traits. Recently, research has demonstrated that psychopathic traits are associated with reduced fixations to the eye regions of faces in samples of children and community-dwelling adults, however this relationship has not yet been established in an offender sample with high levels of psychopathy. In the current study, we employed eye-tracking with paradigms involving the identification and passive viewing of facial expressions of emotion, respectively, in a sample of adult male criminal offenders (n = 108) to elucidate the relationship between visual processing of fearful facial expressions and interpersonal and affective psychopathic traits. We found that the interpersonal-affective traits of psychopathy were significantly related to fewer fixations to the eyes of fear faces during the emotion recognition task. This association was driven particularly by the interpersonal psychopathic traits (e.g., egocentricity, deceitfulness), whereas fear recognition accuracy was inversely related to the affective psychopathic traits (e.g., callousness, lack of empathy). These findings highlight potential mechanisms for the subset of the interpersonal-affective traits exhibited by psychopathic individuals. (PsycINFO Database Record

Empathic Accuracy in Male Adolescents with Conduct Disorder and Higher versus Lower Levels of Callous-Unemotional Traits

Adolescents with disruptive behavior disorders are reported to show deficits in empathy and emotion recognition. However, prior studies have mainly used questionnaires to measure empathy or experimental paradigms that are lacking in ecological validity. We used an empathic accuracy (EA) task to study EA, emotion recognition, and affective empathy in 77 male adolescents aged 13–18 years: 37 with Conduct Disorder (CD) and 40 typically-developing controls. The CD sample was divided into higher callous-emotional traits (CD/CU+) and lower callous-unemotional traits (CD/CU-) subgroups using a median split. Participants watched films of actors recalling happy, sad, surprised, angry, disgusted or fearful autobiographical experiences and provided continuous ratings of emotional intensity (assessing EA), as well as naming the emotion (recognition) and reporting the emotion they experienced themselves (affective empathy). The CD and typically-developing groups did not significantly differ in EA and there were also no differences between the CD/CU+ and CD/CU- subgroups. Participants with CD were significantly less accurate than controls in recognizing sadness, fear, and disgust, all ps < 0.050, rs ≥ 0.30, whilst the CD/CU- and CD/CU+ subgroups did not differ in emotion recognition. Participants with CD also showed affective empathy deficits for sadness, fear, and disgust relative to controls, all ps < 0.010, rs ≥ 0.33, whereas the CD/CU+ and CD/CU- subgroups did not differ in affective empathy. These results extend prior research by demonstrating affective empathy and emotion recognition deficits in adolescents with CD using a more ecologically-valid task, and challenge the view that affective empathy deficits are specific to CD/CU+.

Facial emotion recognition and eye movement behaviour in conduct disorder

BACKGROUND

Conduct Disorder (CD) is associated with impairments in facial emotion recognition. However, it is unclear whether such deficits are explained by a failure to attend to emotionally informative face regions, such as the eyes, or by problems in the appraisal of emotional cues.

METHOD

Male and female adolescents with CD and varying levels of callous-unemotional (CU) traits and age- and sex-matched typically developing (TD) controls (aged 13-18) categorised the emotion of dynamic and morphed static faces. Concurrent eye tracking was used to relate categorisation performance to participants' allocation of overt attention.

RESULTS

Adolescents with CD were worse at emotion recognition than TD controls, with deficits observed across static and dynamic expressions. In addition, the CD group fixated less on the eyes when viewing fearful and sad expressions. Across all participants, higher levels of CU traits were associated with fear recognition deficits and reduced attention to the eyes of surprised faces. Within the CD group, however, higher CU traits were associated with better fear recognition. Overall, males were worse at recognising emotions than females and displayed a reduced tendency to fixate the eyes.

DISCUSSION

Adolescents with CD, and particularly males, showed deficits in emotion recognition and fixated less on the eyes when viewing emotional faces. Individual differences in fixation behaviour predicted modest variations in emotion categorisation. However, group differences in fixation were small and did not explain the much larger group differences in categorisation performance, suggesting that CD-related deficits in emotion recognition were not mediated by abnormal fixation patterns.

Recognition of peer emotions in children with ADHD: Evidence from an animated facial expressions task

A growing body of literature suggests that ADHD is associated with emotion recognition impairments that may be linked to deficient interpersonal functioning. However, our understanding of the mechanisms underlying these recognition impairments is extremely limited. Here, we used dynamic stimuli to investigate whether impaired emotion recognition in children with ADHD may be associated with impairments in perceptual sensitivity. Participants (ADHD: N = 26; Controls: N = 26) viewed video sequences of neutral faces slowly developing into one of the six basic emotional expressions (angry, happy, fearful, sad, disgusted and surprised) and were instructed to indicate via a button press the precise moment at which they were able to correctly recognize the emotional expression. The results showed that compared to controls, children with ADHD exhibited lower accuracy rates across all emotional expressions while there was no evidence for impaired perceptual sensitivity. Thus, the study provides evidence for a generalized categorization impairment across all emotional categories and is consistent with developmental delay accounts of ADHD. Future studies are needed in order to further investigate the developmental course of social cognition deficits in ADHD.

Externalizing Behaviors and Callous-Unemotional Traits: Different Associations With Sleep Quality

Study Objectives

Sleep quality is associated with different aspects of psychopathology, but relatively little research has examined links between sleep quality and externalizing behaviors or callous-unemotional traits. We examined: (1) whether an association exists between sleep quality and externalizing behaviors; (2) whether anxiety mediates this association; (3) whether callous-unemotional traits are associated with sleep quality.

Methods

Data from two studies were used. Study 1 involved 1556 participants of the G1219 study aged 18-27 years (62% female). Questionnaire measures assessed sleep quality, anxiety, externalizing behaviors, and callous-unemotional traits. Study 2 involved 338 participants aged 18-66 years (65% female). Questionnaires measured sleep quality, externalizing behaviors, and callous-unemotional traits. In order to assess objective sleep quality, actigraphic data were also recorded for a week from a subsample of study 2 participants (n = 43).

Results

In study 1, poorer sleep quality was associated with greater externalizing behaviors. This association was partially mediated by anxiety and moderated by levels of callous-unemotional traits. There was no significant relationship between sleep quality and callous-unemotional traits. In study 2, poorer sleep quality, as assessed via self-reported but not objective measures, was associated with higher levels of externalizing behaviors. Furthermore, in study 2, better sleep quality (indicated in both questionnaires and actigraphy measures: lower mean activity, and greater sleep efficiency) was associated with higher levels of callous-unemotional traits.

Conclusions

Self-reports of poorer sleep quality are associated with externalizing behaviors, and this association is partially mediated by anxiety. Callous-unemotional traits are not associated with poor sleep and may even be related to better sleep quality. This is an exceptional finding given that poor sleep quality appears to be a characteristic of most psychopathology.

Impaired social cognition in violent offenders: perceptual deficit or cognitive bias?

Aggressive behavior is assumed to be associated with certain patterns of social information processing. While some theories link aggression to a tendency to interpret ambiguous stimuli as hostile (i.e., enhanced sensitivity to anger), others assume an insufficient ability to perceive emotional expressions, particularly fear. Despite compelling evidence to support both theories, no previous study has directly investigated the predictions made by these two accounts in aggressive populations. The aim of the current study was to test processing patterns for angry and fearful facial expressions in violent offenders (VOs) and healthy controls (CTLs) and their association with self-reported aggression and psychopathy scores. In Experiment 1, we assessed perceptual sensitivity to neutral-emotional (angry, fearful, happy) blends in a task which did not require categorization, but an indication whether the stimulus is neutral or emotional. In Experiment 2, we assessed categorization performance for ambiguous fearful-happy and angry-happy blends. No group differences were revealed in Experiment 1, while Experiment 2 indicated a deficit in the categorization of ambiguous fearful blends in the VO group. Importantly, this deficit was associated with both self-reported psychopathy and aggression in the VO, but not the CTL group. The current study provides evidence for a deficient categorization of fearful expressions and its association with self-reported aggression and psychopathy in VOs, but no support for heightened sensitivity to anger. Furthermore, the current findings indicate that the deficit is tied to categorization but not detection stages of social information processing.