Psychopathic traits in children: Potential for early interventions. Essi Viding Developmental Risk and Resilience Unit, UCL

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1 Psychopathic traits in children: Potential for early interventions Essi Viding Developmental Risk and Resilience Unit, UCL

2 Antisocial behaviour: Different subtypes Callous-unemotional (CU) traits as a sub-typing index Psychopathy in adults Precursors of psychopathy in children AB/CU+ AB CU subtyping used in research, not currently part of diagnostic criteria Under consideration for DSM-V Hart & Hare, 1997 Frick & Viding, 2009 Moffitt et al., 2008

The proposed CU Specifier A child or adolescent would have to meet full criteria for CD and exhibit two of the following four traits over at least a 12

3 The proposed CU Specifier A child or adolescent would have to meet full criteria for CD and exhibit two of the following four traits over at least a 12 month period: 1) lack of remorse or guilt, 2) callous-lack of empathy, 3) shallow or deficient affect, 4) unconcern about performance at school or work

4 CU traits in childhood predict risk for adult psychopathy, violence, aggression etc. Over and above risk prediction afforded by CP Children with CP/CU+ traits: Have more persistent and severe conduct problems than their peers with conduct problems + low CU View proactive aggression as rewarding Frick & Viding, 2009, DPsychopathol

Several studies show that children with CP/CU+ have problems in processing fear and sadness in other people Visual stimuli Vocal stimuli Emotional

5 Several studies show that children with CP/CU+ have problems in processing fear and sadness in other people Visual stimuli Vocal stimuli Emotional processing Report feeling less fear themselves Also less reactive to punishment in standard learning tasks Blair & Viding, 2008; Jones et al., 2010; Marsh et al., 2010

Jones, Happé, Burnett, Gilbert, & Viding, 2010, JCPP 14 13.5 13 12.5 12 11.5 11 10.

6 Jones, Happé, Burnett, Gilbert, & Viding, 2010, JCPP st and 2 nd order ToM ToM Animations: Intentionality Groups Control, CP/CU+, CP/CU- > ASD p<.01 CP/CU+ ASD TD control Groups Control, CP/CU+, CP/CU- > ASD p<.001 CP/CU+ CP/CU- CP/CU- ASD TD control

7 Cognitive/affective correlates of CP/CU+ Children with CP/CU+ are poor at Recognising other people s fear and sadness Learning from punishment But unlike individuals with autism spectrum disorders, they appear to have good theory of mind skills

8 Genes? Twins Early Development Study (TEDS) twins

9 Mean CU Fontaine, Rijsdijk, McCrory & Viding (2010), JAACAP Elevated CU associated with: increased levels of behavioral difficulties and family risk factors at 4 years old higher levels of conduct problems and hyperactivity at 12 years old Age These associations are strongest for the stable high group Stable low (70.2%; 60.3% girls) Increasing (9.6%; 34.6% girls) Decreasing (16.9%; 37.8% girls) Stable high (3.4%; 19.2% girls) Four trajectories of CU identified through general growth mixture modeling: stable high, increasing, decreasing, and stable low. Our findings suggest that stable high CU may be influenced by different etiological factors in girls than in boys Boys Girls h 2 c 2 e 2 h 2 c 2 e 2 Stable High CU 0.78 ( ) 0.01 ( ) 0.21 ( ) 0.00 ( ) 0.75 ( ) 0.25 ( )

10 Is there a difference in the origin of conduct problems between CU+ and CU- children? Early-onset conduct problems (SDQ Conduct Problems scale) CU+ CU- DeFries-Fulker analysis: Top 10% AB, Top 10% +/- CU

11 cp/cu+ Genetic Shared E Non-shared E cp/cu- Genetic Shared E Non-shared E Viding, Blair, Moffitt, & Plomin, 2005, JCPP

12 What genes? Those conferring low emotional reactivity/arousal? (Viding & Jones, 2008; Glenn, 2010) Sadeh et al., 2010 Gene x Environment interaction 5HTTLPR long allele increased risk for developing CU traits in low resource environment Neurodevelopmental genes?

13 Stable high CU strongly heritable in boys Associated with later psychopathology Conduct problems in the presence of CU show strong heritability Genes conferring low emotional reactivity, aberrant neurodevelopment? Why do genes increasing risk for CU survive in the gene-pool? CU one outcome of genetic predisposition; more adaptive outcomes likely Differential susceptibility hypothesis (Jay Belsky)

amygdala activation to other people s fear (Jones et al., 2009; Marsh et al.

14 Brain function and CP/CU+? Compared with typically developing children or those with ADHD, children with CP/CU+ show: lower amygdala activation to other people s fear (Jones et al., 2009; Marsh et al., 2008) In contrast, CP in general can be associated with increased amygdala reactivity to affective stimuli (faces, scenes) (e.g. Decety et al., 2009; Herpertz et al., 2008; Passamonti et al., 2010).

15 Dadds et al., 2008: Children with high levels of CU focus less on the critical eye region when they process fear. Studies needed to further elucidate what might drive differences in amygdala function.

16 Amygdala response to preattentive masked fear in children with conduct problems and CU traits Viding, Sebastian, Dadds, Lockwood, Cecil, de Brito, & McCrory, under review Behavioural data showing fear processing deficits in CP/CU+ may also extend to stimuli presented preattentively (Sylvers, Brennan & Lilienfeld, 2011). Adult data suggest the involvement of the amydala in preattentive fear processing (Whalen et al., 1998). Given evidence of amygdala hypoactivity to consciously perceived fear, and of deficits in preattentive fear processing in CP/CU+, amygdala hypoactivity to preattentively presented fear was predicted for this group. Amygdala hyperactivity was predicted in CP/CU-.

17 Masked Fear Task Fear Condition Calm Condition Target Backward Mask Target Backward Mask vs. 17ms 183ms 300ms ISI 17ms 183ms 300ms ISI Identity of target and mask always differed. Equal male and female faces. Based on series of papers by the Whalen group.

18 *Data slides have been removed as the data are not published yet. The findings are summarised below. Findings demonstrate differential amygdala activity to subliminally presented fear in CP/CU+ vs. CP/CU-. TD Controls showed an intermediate response in this region. Suggests a deficit in detecting and representing fear is present at the earliest levels of processing in CP/CU+; may explain lesser orienting to the eye region A continuous relationship between amygdala response and CU traits in children with conduct problems. Highlights possible heterogeneity of emotional responsivity in children with CP; those with highest levels of CU are least responsive to other people s distress at neural, as well as behavioural level

19 Environmental risk? Non-shared (child specific) environmental factors important for both CP and CU Negative/harsh parental discipline a candidate nonshared environmental factor for both CP - well documented association with negative/harsh parental discipline CU - a number of studies to date document association (e.g. Fontaine et al., 2010; Viding et al., 2009; Waller, Gardner et al., 2011) Are differences in CP or CU between identical twins due to differences in parenting?

20 BJP, 2009 MZ twins are genetically identical Differences between MZ twins due to environmental factors not shared by the twins We measured negative parental discipline at age 7 ; conduct problems and callous-unemotional traits at 12 Question: Do MZ differences in negative parental discipline at age 7 relate to MZ differences in CP or CU at age 12? YES! for CP NO! for CU

Negative parental discipline represents a non-shared environmental risk factor for development of further CP, but not CU We know that E influences for CP and CU have only modest overlap

21 Negative parental discipline represents a non-shared environmental risk factor for development of further CP, but not CU We know that E influences for CP and CU have only modest overlap (Viding et al., 2007) The phenotypic relationship between negative parental discipline and level of CU traits may reflect genetic endowment within families who have a child with CU traits

22 Association between parenting and conduct problems in children with low vs. high levels of CU traits Poor parenting associated with higher symptom count of CP in children with low levels of CU. No association between parenting and conduct problems for those with high levels of CU. (e.g. Wootton et al., 1997; Oxford et al., 2003; Hipwell et al., 2007)

23 Pasalich, Dadds, Hawes, & Brennan (2011) Coercive parenting associated with CP in boys with CU-, but not CU+ Parental warmth negatively associated with CP in boys with CU+, but not CU- In summary, poor parenting does not appear to make conduct problems worse in children with high levels of CU traits, but warm parenting can reduce conduct problems in these children. Neurocognitive data suggest that children with high levels of CU have relatively normal ability to process rewards

24 SUMMARY CP Similar behaviour, but by different mechanisms CU traits designate a subgroup of children who are genetically vulnerable to conduct problems and who display atypical affect/empathy Children who have CP/CU+ do not get aroused by other people s distress or punishments/sanctions But appear to have a relatively intact processing of rewards Children with CP/CU- have intact or increased emotional arousal. Well placed to learn from empathy induction, sanctions and rewards

25 SUMMARY Implications for intervention prosociality, but by slightly different means? What is in it for me? How may good behaviour guarantee access to rewards and privileges. Attention to other people s emotions?

Acknowledgements Developmental Risk & Resilience Unit Eamon McCrory Catherine Sebastian Stephane De Brito Charlotte Cecil Patricia Lockwood Funding ESRC MRC

26 Acknowledgements Developmental Risk & Resilience Unit Eamon McCrory Catherine Sebastian Stephane De Brito Charlotte Cecil Patricia Lockwood Funding ESRC MRC British Academy TEDS, Schools, families and children Collaborators/former lab members Robert Plomin, Fruhling Rijsdijk, Francesca Happe, Alice Jones, Nathalie Fontaine

Why do some children develop serious and persistent anti-social behaviour?

Why do some children develop serious and persistent anti-social behaviour? Prof Essi Viding Professor of Developmental Psychopathology, UCL @EssiViding www.drru-research.org Ted Bundy (1946-1989) Serial