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Concept: Conduct disorder

169

Recent studies have shown that while psychopathy and non-psychopathic antisociality overlap, they differ in the extent to which cognitive impairments are present. Specifically, psychopathy has been related to abnormal allocation of attention, a function that is traditionally believed to be indexed by event-related potentials (ERPs) of the P3-family. Previous research examining psychophysiological correlates of attention in psychopathic individuals has mainly focused on the parietally distributed P3b component to rare targets. In contrast, very little is known about the frontocentral P3a to infrequent novel events in psychopathy. Thus, findings on the P3 components in psychopathy are inconclusive, while results in non-psychopathic antisocial populations are clearer and point toward an inverse relationship between antisociality and P3 amplitudes. The present study adds to extant literature on the P3a and P3b in psychopathy by investigating component amplitudes in psychopathic offenders (N = 20), matched non-psychopathic offenders (N = 23) and healthy controls (N = 16). Also, it was assessed how well each offender group was able to differentially process rare novel and target events. The offender groups showed general amplitude reductions compared to healthy controls, but did not differ mutually on overall P3a/P3b amplitudes. However, the psychopathic group still exhibited normal neurophysiological differentiation when allocating attention to rare novel and target events, unlike the non-psychopathic sample. The results highlight differences between psychopathic and non-psychopathic offenders regarding the integrity of the neurocognitive processes driving attentional allocation, as well as the usefulness of alternative psychophysiological measures in differentiating psychopathy from general antisociality.

Concepts: Psychology, Neuroscience, Crime, Differential equation, Antisocial personality disorder, Conduct disorder, Psychopathy, Antisocial

145

This review considers juvenile delinquency and justice from an international perspective. Youth crime is a growing concern. Many young offenders are also victims with complex needs, leading to a public health approach that requires a balance of welfare and justice models. However, around the world there are variable and inadequate legal frameworks and a lack of a specialist workforce. The UK and other high-income countries worldwide have established forensic child and adolescent psychiatry, a multifaceted discipline incorporating legal, psychiatric and developmental fields. Its adoption of an evidence-based therapeutic intervention philosophy has been associated with greater reductions in recidivism compared with punitive approaches prevalent in some countries worldwide, and it is therefore a superior approach to dealing with the problem of juvenile delinquency.

Concepts: Childhood, Crime, Children, Psychiatry, Criminology, Juvenile delinquency, Conduct disorder, Juvenile delinquency in the United States

107

Humans are intrinsically social animals, forming enduring affiliative bonds [1]. However, a striking minority with psychopathic traits, who present with violent and antisocial behaviors, tend to value other people only insofar as they contribute to their own advancement [2, 3]. Extant research has addressed the neurocognitive processes associated with aggression in such individuals, but we know remarkably little about processes underlying their atypical social affiliation. This is surprising, given the importance of affiliation and bonding in promoting social order and reducing aggression [4, 5]. Human laughter engages brain areas that facilitate social reciprocity and emotional resonance, consistent with its established role in promoting affiliation and social cohesion [6-8]. We show that, compared with typically developing boys, those at risk for antisocial behavior in general (irrespective of their risk of psychopathy) display reduced neural response to laughter in the supplementary motor area, a premotor region thought to facilitate motor readiness to join in during social behavior [9-11]. Those at highest risk for developing psychopathy additionally show reduced neural responses to laughter in the anterior insula. This region is implicated in auditory-motor processing and in linking action tendencies with emotional experience and subjective feelings [10, 12, 13]. Furthermore, this same group reports reduced desire to join in with the laughter of others-a behavioral profile in part accounted for by the attenuated anterior insula response. These findings suggest that atypical processing of laughter could represent a novel mechanism that impoverishes social relationships and increases risk for psychopathy and antisocial behavior.

Concepts: Psychology, Sociology, Behavior, Human behavior, Premotor cortex, Antisocial personality disorder, Conduct disorder, Psychopathy

99

Psychopathy is a personality disorder associated with a profound lack of empathy. Neuroscientists have associated empathy and its interindividual variation with how strongly participants activate brain regions involved in their own actions, emotions and sensations while viewing those of others. Here we compared brain activity of 18 psychopathic offenders with 26 control subjects while viewing video clips of emotional hand interactions and while experiencing similar interactions. Brain regions involved in experiencing these interactions were not spontaneously activated as strongly in the patient group while viewing the video clips. However, this group difference was markedly reduced when we specifically instructed participants to feel with the actors in the videos. Our results suggest that psychopathy is not a simple incapacity for vicarious activations but rather reduced spontaneous vicarious activations co-existing with relatively normal deliberate counterparts.

Concepts: Psychology, Personality psychology, Mental disorder, Emotion, Personality disorder, Antisocial personality disorder, Conduct disorder, Personality disorders

76

Psychopathy is associated with persistent antisocial behavior and a striking lack of regret for the consequences of that behavior. Although explanatory models for psychopathy have largely focused on deficits in affective responsiveness, recent work indicates that aberrant value-based decision making may also play a role. On that basis, some have suggested that psychopathic individuals may be unable to effectively use prospective simulations to update action value estimates during cost-benefit decision making. However, the specific mechanisms linking valuation, affective deficits, and maladaptive decision making in psychopathy remain unclear. Using a counterfactual decision-making paradigm, we found that individuals who scored high on a measure of psychopathy were as or more likely than individuals low on psychopathy to report negative affect in response to regret-inducing counterfactual outcomes. However, despite exhibiting intact affective regret sensitivity, they did not use prospective regret signals to guide choice behavior. In turn, diminished behavioral regret sensitivity predicted a higher number of prior incarcerations, and moderated the relationship between psychopathy and incarceration history. These findings raise the possibility that maladaptive decision making in psychopathic individuals is not a consequence of their inability to generate or experience negative emotions. Rather, antisocial behavior in psychopathy may be driven by a deficit in the generation of forward models that integrate information about rules, costs, and goals with stimulus value representations to promote adaptive behavior.

Concepts: Decision making, Decision theory, Mental disorder, Emotion, Antisocial personality disorder, Conduct disorder, Psychopathy, Remorse

28

Background:  Childhood behavioral disorders including conduct disorder (CD), oppositional defiant disorder (ODD), and attention-deficit/hyperactivity disorder (ADHD) often co-occur. Prior twin research shows that common sets of genetic and environmental factors are associated with these various disorders and they form a latent factor called Externalizing. The developmental propensity model posits that CD develops in part from socioemotional dispositions of Prosociality, Negative Emotionality, and Daring; and recent research has supported the expected genetic and environmental associations between these dispositions and CD. This study examined the developmental propensity model in relation to the broader Externalizing factor that represents the covariance among behavior disorders in children. Methods:  Parents of 686 six- to twelve-year-old twin pairs rated them on symptoms of CD, ADHD, and ODD using the disruptive behavior disorder scale and on Prosociality, Negative Emotionality, and Daring using the Child and Adolescent Dispositions Scale. A latent factor multivariate Cholesky model was used with each disposition latent factor comprised of respective questionnaire items and the Externalizing factor comprised of symptom dimensions of CD, ADHD inattention, ADHD hyperactivity/impulsivity, and ODD. Results:  Results supported the hypothesis that the socioemotional dispositions and the Externalizing factor have genetic factors in common, but there was not a single genetic factor associated with all of the constructs. As expected, nonshared environment factors were shared by the dispositions and Externalizing factor but, again, no single nonshared environmental factor was common to all constructs. A shared environmental factor was associated with both Negative Emotionality and Externalizing. Conclusions:  The developmental propensity model was supported and appears to extend to the broader externalizing spectrum of childhood disorders. Socioemotional dispositions of prosociality, negative emotionality, and (to a lesser extent) daring may contribute to the covariation among behavioral disorders and perhaps to their comorbid expression through common sets of primarily genetic but also environmental factors.

Concepts: Genetics, Environment, Child, Conduct disorder, Oppositional defiant disorder

28

The purpose of this study was to test the factor structure of the Inventory of Callous-Unemotional Traits (ICU; Frick, 2004 ) and to study the relation between the derived dimensions and external variables in a community sample of preschool children. A total of 622 children 3 and 4 years of age were assessed with a semistructured diagnostic interview, the ICU, and other questionnaires on psychopathology, temperament, and executive functioning, completed by parents and teachers. Confirmatory factor analysis derived from teachers' ICU responses yielded three dimensions: Callousness, Uncaring, and Unemotional. Callousness and Uncaring subscale scores correlated with the specific scales related to aggressive behavior, temperament, executive functioning, and conduct problems. The ICU scale scores discriminated cross-sectionally oppositional defiant disorder (ODD) and conduct disorder (CD) diagnoses, aggressive and nonaggressive symptoms of CD, use of services, and ODD/CD-related family burden. Longitudinally, Callousness subscale score at age 3 predicted ODD or CD diagnosis at age 4. Unemotional was not associated with aggressive measures, but it was linked to anxiety disorders cross-sectionally and longitudinally. Callous-Unemotional traits contributed significantly to predicting disruptive behavior disorders controlling for sex, temperament, and executive functioning (predictive accuracy between 3 and 5%). The ICU is a promising questionnaire for identifying early Callous and Uncaring traits in preschool years that may help in the identification of a subset of preschool children who might have severe behavioral problems.

Concepts: Psychology, Confirmatory factor analysis, Conduct disorder, Oppositional defiant disorder

27

Psychopathy is a disorder that is characterized by marked emotional deficiencies. Because previous studies suggest that an individual’s sensitivity to bodily signals-or “interoceptive awareness”-is associated with various components of emotional functioning, the authors expected this capacity to be reduced in psychopathic individuals. Therefore, the current study examined the relationship between psychopathy and interoceptive awareness by assessing heartbeat detection abilities in a group of 75 male personality disordered offenders, varying in their degree of psychopathy, as assessed with the Hare Psychopathy Checklist-Revised (PCL-R; Hare, 2003). Regression analyses revealed that PCL-R Facet 4, which reflects antisocial behavior, was predictive of reduced interoceptive awareness. These findings suggest that the expression of psychopathic behavior might be influenced by an attenuated sensitivity to one’s own bodily signals.

Concepts: Mental disorder, Antisocial personality disorder, Conduct disorder, Psychopathy, Hare Psychopathy Checklist, Robert Hare, Remorse, The Mask of Sanity

27

Objective: To compare the results of categorically based versus dimensionally based scoring algorithms for a Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV)-referenced teacher rating scale for assessing ADHD and commonly co-occurring conditions and to determine their relative agreement with ratings of symptom-induced impairment. Method: Teachers completed Child and Adolescent Symptom Inventory-4R (CASI-4R) ratings for 1,092 youth (ages 6-18 years) referred to a child and adolescent psychiatry outpatient service. Caseness was determined according to DSM-IV symptom count (categorical model) and T-score (dimensional model) criteria. Results: Agreement between symptom count and T-score cutoffs was generally good (kappa ≥ 0.61) for ADHD-Inattentive, ADHD-Hyperactive-Impulsive, ADHD-Combined (except adolescent females), Oppositional Defiant Disorder, and Conduct Disorder, but this was not the case for anxiety and depressive disorders where only 15% of kappas were good. Agreement of impairment cutoff with T-score and symptom count cutoffs ranged from poor to good. Conclusion: In general, although in many cases CASI-4R categorical and dimensional scoring algorithms generated similar results, there was considerable variability across disorders, age groups, scoring method, and in some cases, gender. Moreover, symptom counts and T-scores are not a proxy for assessing impairment suggesting that each scoring strategy likely provides unique information for clinical decision-making. (J. of Att. Dis. 2013; XX(X) 1-XX).

Concepts: Model theory, Mental disorder, Major depressive disorder, Psychiatry, Antisocial personality disorder, Conduct disorder, Oppositional defiant disorder, Mathematical logic

25

Remorse has long been important to the juvenile justice system. However, the nature of this construct has not yet been clearly articulated, and little research has examined its relationships with other theoretically and forensically relevant variables. The present study was intended to address these issues by examining relationships among remorse, psychopathology, and psychopathy in a sample of adolescent offenders (N = 97) using the theoretically and empirically established framework of guilt and shame (Tangney & Dearing, 2002). Findings indicated that shame was positively related to behavioral features of psychopathy, whereas guilt was negatively related to psychopathic characteristics more broadly. In addition, shame was positively associated with numerous mental health problems whereas guilt was negatively associated with anger, depression, and anxiety. These results provide empirical support for theory that psychopathy is characterized by lack of remorse (e.g., Hare, 1991), and also underscore shame and guilt as potentially important treatment targets for adolescent offenders. (PsycINFO Database Record

Concepts: Psychology, Mental disorder, Conduct disorder, Psychopathy, Empirical research, Guilt, Remorse, Shame