Callous-Unemotional Traits in Children PDF

PS3112 Clinical Psychology Callous-unemotional (CU) traits in children Celine Chhoa [email protected] Content warning Please note that the following themes will be covered in this session: Child abuse (emotional, mental,...

PS3112 Clinical Psychology Callous-unemotional (CU) traits in children Celine Chhoa [email protected] Content warning Please note that the following themes will be covered in this session: Child abuse (emotional, mental, physical, sexual, verbal) Mental health difficulties You may take a break during this session if necessary. If you are affected by these topics, please be aware of our available support information 2 for students and Intended learning outcomes Describe the core features of CU traits Understand the clinical significance of CU traits in behavioural disorders Understand the development of CU traits Describe the emotional and neurobiological correlates of CU traits and understand their role in empathy and emotional responses Understand challenges to treatment of disruptive behaviour disorders for children with CU traits Evaluate emerging treatment approaches 3 Overview Definition of CU traits Clinical significance Core deficits of CU traits  Emotional processing  Reinforcement learning  Social affiliation Development CU traits Treatment and intervention  Challenges 4 What are callous-unemotional traits? Downward extension of psychopathy to children Four core features of CU traits  Lack of remorse and guilt  Callous-lack of empathy  Shallow or blunted affect (unemotionality)  Unconcerned about performance at school 5 Psychopathic traits in children? Similar presentation and correlates to adults with psychopathy (Frick & Ray, 2014) Reliably measured in children as young as 2 years  CU traits in preschoolers correlated with expected constructs including empathy, prosocial behaviour, aggression, and less attention to images of people in distress (Kimonis et al., 2016)  CU traits at age 2 predicted behaviour problems at age 3 and 4 (Hyde et al., 2013)  CU traits at ages 2-4 predicted CU traits, aggressive behaviour and rule-breaking at age 9 (Waller et al., 2016) Stable across childhood (Fontaine et al., 2011) 6 Clinical significance of CU traits Designate a particularly severe and Antisocial impaired subgroup of antisocial children CU More severe Unique neural, conduct psychophysiological, problems cognitive and Longman et al. behavioural (2015) characteristics Frick et al. (2014) Persistence into adulthood Rowe et al. (2010) 7 Clinical significance of CU traits: Subtype of conduct disorder Low CU High CU Affective Emotional / Anxious ‘Blunted’ emotionality Cognitive- Less reactive to Hostile attribution bias affective emotional cues Behavioural Reactive aggression Proactive aggression Behavioural Reward seeking Punishment insensitive Genetic Moderate heritability High heritability Treatment Effective Resistant to treatment Clinical significance of CU traits Specifier for Conduct Disorder in the DSM-5 – ‘Limited Prosocial Emotions’  Callousness / lack of empathy  Lack of guilt and remorse  Lack of concern about performance at school  Shallow affect Children who met criteria for the LPE specifier had higher levels of:  Externalising problems: physical and relational aggression  Bullying  Cruelty  Comorbidity: ODD, ADHD 9  Clinical significance of CU traits Future Delinquency psychopathy Marsee et al. Hawes et al. (2017) (2005) Poor Contact with long- Antisocial criminal justice term personality system disorder outcom Kahn et al. (2013) McMahon et al. (2010) es Poor Substance interpersonal abuse relationships Sakki et al. (2023) 10Vaughan et al. (2022) Core deficit of CU traits: Emotion processing Emotional reactivity Biological response (autonomic  Distressing stimuli activity)  EMG of facial muscles  Heart rate  Emotional film clips (The Lion King)  Skin conductance levels  Startle eyeblink reflex Emotion recognition  Fear  Faces, body postures, vocal tones  Attention to the eyes Neural correlates  Amygdala hypoactivity 11 Core deficit of CU traits: Reinforcement learning Response preservation Passive avoidance  Tendency to persist in a behaviour that  Learn through trial and error was previously rewarded despite potential punishment 12 Reinforcement learning: Theories Reinforcement sensitivity theory (Gray,1987) Integrated emotion systems model (Blair, 2004) Response modulation hypothesis (Newman et al., 1997) Reinforcement learning: A conduct problems example 1 2 3 4 14 Reinforcement learning: What about punishment insensitivity? 1 2 3 4 Development of CU traits: The role of parenting Parenting is a well-established risk factor for antisocial behaviour Parent Coercive cycles request Target of intervention Parent escalate What does this mean for children s or Child with CU traits? withdraw refuses CU traits associated with low s & gives in response to punishment Disrupts parent attempts to discipline If child is insensitive to discipline:  Does parenting even have an Child Parent escalate escalate effect on child behaviour? s s  Does parent become harsher 16 over time? CU traits and parenting Does parenting even have an effect on behaviour of children with CU traits? Negative parenting practices more strongly associated with behaviour problems in children low in CU traits  Crum et al. (2015); Edens et al. (2008); Hipwell et al. (2007); Pasalich et al. (2011); Wootton et al, (1997) Suggests children high in CU traits are harder to parent and parenting will not affect their behaviour Criticisms:  Cross-sectional studies  Definition of negative parenting was broad  Mix of inconsistent parenting, poor supervision, corporal punishment 17  CU traits and parenting Early Steps Project, USA  Waller et al. (2014) Harsh parenting: observation Warm parenting: speech samples Findings: Harsh parenting related to increases in CU traits over time Warm parenting related to decreases in CU traits over time CU traits related to decreases in warm parenting over time Waller et al. (2012, 2014, 2016, 2018) 18 Gene-environment effects: Adoption studies Passive gene-environment correlation Evocative gene-environment correlation Early Growth and Development Study (EGDS)  Hyde et al. (2016) Biological mother severe antisocial behaviour.16 H*e*r itab Adoptive mother -.19** le p a th positive Non-heritable way Child CU pathway reinforcement t behaviours e n Biological mother n m 17 ** nviro severe antisocial -. e xe behaviour x n Ge Adoptive mother positive 19 reinforcement Gene-environment effects: Twin studies Difference in parentings for identical (MZ) twins Same genes but different experience (non-shared environment) MSU Twin Study of Behaviour and Emotional Development in Children  Waller et al. (2018) MZ twin difference.46*** MZ twin in parental difference in harshness aggression.31*** MZ twin difference MZ twin -.16* in parental difference in CU warmth traits 20 What is being passed on from birth parents? Early traits  Fearlessness  Low emotional responsivity  Reward and punishment sensitivity 21 CU traits evoke harsher parenting Early Growth and Development Study  Trentacosta et al. (2019) 22 Treatment of CU Traits Current ‘best practice’ interventions: parenting programmes  National Institute for Health and Care Excellence (NICE) guidelines Core components: Child behaviour management strategies Parent-child relationship enhancement Why might these kinds of interventions be a problem for children with CU traits? 23 24 Treatment of CU Traits CU traits associated with poorer treatment outcomes of parenting programmes  Waller et al. (2013)  Hawes & Dadds (2014) 25 Hyde & Dotterer (2023) Treatment of CU Traits Hyde & Dotterer (2023) 26 Treatment of CU Traits: Current approaches Standard treatment De-emphasise punishment- based strategies Emotion training Emphasise reward-based strategies 27 Treatment of CU Traits: Emotion training Dadds et al (2019) Eye gaze to improve social bonding 3 groups: – PMT + emotional engagement (EE) – PMT + child-centred play (CCP) – PMT only Improvements in emotional engagement and shared eye gaze But these reduced back to normal very quickly 28 Treatment of CU Traits: Emotion training PCIT-CU adjunctive module designed to increase emotional responsivity to others’ distress 1. enhance attention to critical facial cues signalling distress to improve emotion recognition 2. improve emotional understanding by linking emotional expression to context and identifying situations that trigger anger and frustration in the child 3. teach and positively reinforce prosocial and empathic behaviour with parent modelling, role-play, and social stories 4. increase frustration tolerance through modelling, role-play, and reinforcing use of learned cognitive- behavioural strategies to decrease the incidence of aggressive behaviour 29 Treatment of CU Traits: Emotion training Kimonis et al (2019) Pilot study (N = 23) No control condition Significant decreases in CU traits which were sustained at 3 months post treatment Similar findings in proof- of-concept RCT (Fleming et al., 2022) 30 Treatment of CU Traits: Emphasising rewards Punishment insensitivity Emotionally unaffected by time-out (Hawes & Dadds, 2005) Less emotion and more negative behaviour during time-out (Garcia et al., 2018) Positive reinforcement related to decreased CU traits (Hyde et al, 2016) Parental praise and tangible rewards associated with lower CP in children high in CU traits (Clark & Frick, 2018) 31 Treatment of CU Traits: Emphasising rewards Waschbusch et al. (2019) 8-week intensive summer treatment programme Modified behaviour therapy vs. standard behaviour therapy Reward-emphasised & punishment-deemphasised Gained points for positive behaviours but did not lose points for negative behaviours Serious misbehaviour resulted in timeout But this could be decreased by behaving well in timeout Extra reward system in addition to token system  ‘Caught you being good’ ticket 32 Treatment of CU Traits: Emphasising rewards 33 Treatment of CU Traits: Emphasising rewards Tangibl Social e reward reward s s Which form of rewards are most effective for children who are high in CU traits? 34 Punishment and reward sensitivity * 35 Reward preferences * 36 Reward preferences * * 37 Considerations and conclusions Age differences in reward preferences Developmental changes Role of parent-child relationship quality Help inform existing evidence-based positive parenting and discipline strategies Provide a better fit with individual child and family needs 38 39