Please enable JavaScript.
Coggle requires JavaScript to display documents.
Emotion Dis: Externalising - Conduct (Behaviour (Externalising (Onset (any…
Emotion Dis: Externalising - Conduct
Behaviour
Externalising
Maladaptive emotions + cognitions manifested in outer behaviour
This behaviour is often antisocial causes harm to others, + interferes with daily function
Anti social - harming animals, aggression towards others, bullying
DSM-5: Disruptive, impulse control and conduct disorder
Onset (childhood/adolescence)
Oppositional defiant disorder (> ASPD)
Conduct disorder - accompanied by setting fires - pyromania symptoms
Onset (any age)
Substanc misuse
Pyromania/Kleptomania
Intermittent Explosive disorder - uncontrolled rage
Diagnosed in adults
Antisocial Personality Disorder (requires CD in childhood)
Diagnostic criteria
Antisocial behaviour in young people
Destruction of property
Theft
Truency
Aggression to people or animals
Anti-social/harmful to society
3+ symptoms in past 12 mnths. 1 in past 6 mnths (severe/sustained)
Severity of impact on daily function (self/others), age of onset, and 'limited prosocial emotional' (callous-unemotional) specifiers
ODD (precursor) more common in children <11yrs; CD in those > 11yrs
Prevalence
More prevalent in males (2:1
More prevalent in children with low SES
Prevalence around 5% in 5-16 yrs
Common (40%) in children who are looked after, abused, or on child protection registers
One of the most common reasons for referral to CAMHS
Huge social and financial costs - emotional cost on victims of antisocial
Comorbidity
Up to 40% with CD diagnosis also meet criteria for ADHD (mismanagement of behaviour issues - behaviour + antisocial so become more)
Up to 50% with CD will be diagnosed with ASPD as adults
Also common: anxiety, depression (emotional disorder), substance misuse, poor literacy (difficulties in class leads to playing up), and other learning difficulties
46% boys + 36% girls with CD have at least one other condition
Heterogeneity
Highly heterogeneous
Early vs. adolescent onset
Reactive (provides emotional reaction) vs. proactive/instrumental (chosen to be aggressive in order to reach goal) aggression
Trajectory and stability of behaviours over time
Presence or absence of callous-unemotional traits
Overt (directly hurt) vs. covert (don't openly aggress) behaviours
Age trajectories
Moffitt (1993)
theory of a dual taxonomy of antisocial behaviour: adolescent-limited and life course persistent
Age crime curve - widely observed across different crimes
Majority of crime is adolescent-limited + due to social/peer factors
Minority show early antisocial behaviour that persists throughout life
Adolescent limited = peak in adolescence/early adulthood
Life course persistent: offenders offend whole life - resistant to intervention
Callus-Unemotional Traits
Increasing evidence for subtypes - lack go guilt/empathy: callous use of others, unemotional/uncaring aspects
Strong relationship between childhood CU traits and adult psychopathy
Often co-occurs with CD (severe)
Limited prosocial emotion diagnostic specifier recently added
10-15% CDs meet criteria > sig minority
CD/High CU more likely to have early onset CD that is resistant to intervention (life course persistent)
Those with CD/low CU more likely to be adolescent onset on/or-limited
Why important?
Helps is to understand equifinality i.e. different causal routes to same behavioural outcome
Different subtypes may respond differentially to recommended treatment
Some interventions may be ineffective or harm, e.g. empathy-based anti-bullying programmes in high CU traits
Difficult to understand the causal pathways to disorder if ill-defined
Aetiology
Causal pathways in CD
Equifinality
Same developmental outcome can result for differing pathways
E.g. superficially similar antisocial behaviour - with/out CU traits
Multifinality
The same risk factors can have multiple developmental outcomes
E.g. different children with similar CU = not similar levels of antisocial behaviour
G + E
Environmental (poor parenting, family conflict, poor ed achievement, peer influence) = more important in CD/low CU
Twin studies: anti social behaviour is more heritable in CD/High CU (80%) than in CD/low CU (30%)
Similar behaviour across subtypes, but differing aetiologies
Heritability of CU traits themselves is 40-70%
Molecular Genetics
Some non-replications - need large samples
May be that few studies take heterogeneity into account (messy data set)
Candidate genes identified, mostly involved in neurotransmission
May be due to interaction
Regions on chromosomes 2 and 19 may cover CD risk
GE Interaction
Caspi et al (2002)
MAOA-Low gene variant
Associated with increased antisocial behaviour (depends on certain enviro for negative effects)
Only suffered maltreatment (increased odds - not deterministic)
Act via reactive aggression
Hyde et al (2016)
CU traits + parenting style
Design
Adoption cohort of 561 families
Assessed
History of antisocial behaviour: biological mothers
Observations of +ive parenting: adoptive mothers
Early externalising behaviours: children at 27 mnths
Videos coded for +ive reinforcement with child = 18 mnths
Findings
Effect = reduced is adoptive mother used +ive reinforcement
Buffering effect: slightly different example of ExE interaction
Cu traits associated with biological mother antisocial behaviour, despite little contact: some genetic influence
Neurobiology + Cognition
Neural bases
Brain structures
Region associated with emotion processing + decision-making, can't know causality
Meta-analysis of 394 youths with externalising conditions and 350 cohorts
Rogers & De Brito (2016)
Reduced grey matter volumes in amygdala, insula, and parts of prefrontal + temporal cortices
CU traits
Left OFC reduced in CP/HCU compared with CP/LCU
Effect driven by CU traits rather than CD symptoms
OFC - learning, reward, motivation, social/moral behaviour
Reduced grey matter vol. in L middle frontal gyrus + bilateral orbitofrontal cortex in adolescents ages 10-16 with CP
Structure NOT function
Sebastian et al (2015)
Key neurocognitive processes
Basic Emotion Processing
Behaviour + cognition
Children with CP/HCU = less accurate in identifying fear/sadness in others
Report feeling less fear and under-arousal to emotional/empathy inducing stimuli (don't recognise in others)
Contrast = CD/LCU show over arousal to emotional stimuli
CD children show reduced cortisol + heart rate reactivity to stress
E.g. interpreting neutral faces as hostile: hostile attribution bias - neutral face as angry (react hostile way when unwarranted)
Fear processing in eye region
Shorter + fewer fixations on eye region of fearful faces
Aren't automatically orienting to eyes of fearful face - hard to recognise, less associations so do understand
Instructed to focus on eye region > far recognition accuracy improves
Could reduced orienting to fear + distress reduce opportunity to learn from social cues - to deve responding? deve account
Fear recognition deficits in children with HCU
Neural responses to emotion in CD
Increased amygdala responses to neutral faces in CD
Reduced response to angry face in amygdala, OFC, PFC and insula in CD youths aged 16-21
Passamonti et al (2010)
Lower response in amygdala to sad faces in early-onset (more severe) CD
Neurophysiological abnormalities
Early onset more persistent/severe than adult
Mixed findings in CD as whole
Partly due to co-morbid anxiety/depression (amygdala hyperactivity) found reduced amygdala response in CD only after controlling
Looking across CD as whole, some also increased amygdala response to emotional pictures
Herpertz et al (2008)
Shows importance of characterising samples well
Empathy
Neurocog bases
But often those with LCU display reactive aggression, and empathise for the victim/show remorse once they are calm
Those with HCU more often display proactive aggression + show reduced empathy/remorse
Behaviour in CD suggests a lack of empathy
Neural Responses to Others' Pain
Lockwood et al (2013)
Reduced mean response in 37 Cps aged 10-16yrs
Anterior Insula
Interoceptive awareness
Awareness of unpleasant feelings
Sensory integration
Correlates with subjective pain ratings
Anterior Cingulate Cortex
Correlates with subjective pain ratings
Mediates decision responses to pain?
Coupled with AI during empathy for pain
Interior Frontal Gyrus
Pain suppression
Regulation of emotional responses to pain
Responses vary
Increased response to others' pain as CD symptoms increase
Again useful to take heterogeneity into account
Decrease response to others' pain as callous traits increase
ToM Deficit
Jones et al (2010)
Typical ToM in this group. Consistent with psychopathy: individuals can manipulate others, so have understanding of thought/motivations
Contrast - CD/HCU = less concerned about others' distress + reported lower levels of fear
Social cog deficits in CD/HCU = very different from those in autism
Cartoon vignette task
Cognitive ToM - Correct answer involves understanding intentions
Physical causality - correct answer involves cause and effect reasoning
Comparing CP/HCU + ASD
Sebastian et al (2014)
CP/HCU, ASD, TD controls
Groups matched on age, SES, NVIQ, ethnicity, handedness, behavioural response
Medial PFC regions showed reduced response in ASD only: associated with greater symptoms
Results not explained by group differences in ADH, depression or anxiety
'Hot' Executive Functions
Neurocog bases
But inhibitory control does seem to be impaired after controlling for ADHD
CD particularly impaired at 'hot' EF tasks: EF in the presence of rewarding, punishing or emotional stimuli
Meta analysis of 'cool' EFs in CD suggested EF deficits likely due to comorbid ADHD
Punishment insensitivty
Reinforcement learning
Emotion regulation
Punishment insensitivity
Gao et al (2010)
Implicated amygdala-OFC circuitry and a lack of fear or 'socialising punishment' over development
Those with criminal records showed reduced fear condition at age 3 compared to a matched comparison group
3 yrs given a similar task and follow up at 23
Reduced anticipatory skin-conductance to aversive white noise burst in 'psychopathy prone' adolescents
Reinforcement learning
Finger et al (2011)
Passive avoidance learning task
Ps must learn which items win points (select) and which items lose points (avoid)
Results
Consistent with Blair's theory of atypical OFC-amygdala circuitry
Could underpin repetition of same mistakes in everyday life
Reduced OFC response when learning associations, and in response to rewards
No CD/LCU comparison group
CD youth with psychopathic traits (HCU) found is harder to learn which items to avoid
Poor emotional control
Asking CP/LCU to focus on the fear/eyes slowed their responses
Slower reaction times associated with greater amygdala response
Simple decision-makig task: is there a dot present on the face?
No effect in CP/HCU group
Sebastian et al (2014)