BackgroundSince the introduction of the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5, a limited prosocial emotion (LPE) specifier has been added to the conduct disorder (CD)... Show moreBackgroundSince the introduction of the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5, a limited prosocial emotion (LPE) specifier has been added to the conduct disorder (CD) diagnosis in addition to the age of onset specifier. It was suggested that this would identify a subgroup with severe antisocial and/or aggressive behavior with serious current and future (mental health) impairment. Research in recent years has shown that this is indeed a subgroup with severe antisocial behavior; however, mental health problems do not appear to differ from those of youth with CD without LPE. Most research to date has been cross-sectional. However, longitudinal research is urgently needed to better understand the predictive value of the LPE specifier. The aim of the current longitudinal study is to examine future offending behavior of youth with CD with compared to youth without the LPE specifier. In addition, the predictive value of the categorical LPE specifier and the dimensional LPE score will be examined beyond factors that are strongly associated with future offending (i.e., gender, age, and prior offending).MethodsAdolescents and young adults (12-25) with CD (assessed with the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version [K-SADS-PL]) with (N = 61) and without (N = 75) the LPE specifier (assessed with the Callous-Unemotional [CU] dimension of the Youth Psychopathic traits Inventory [YPI]) (in line with Jambroes et al., 2016) were compared on sociodemographic characteristics, mental health problems and offending behavior. Future (general and violent) offending was based on official conviction data.ResultsOur results showed that youth with CD with and without the LPE specifier did not differ in self-reported and informant-reported mental health problems. However, youth with CD with the LPE specifier showed more offending behavior and personality pathology at baseline. In addition, the categorical LPE specifier was associated with future general offending, but not with future violent offending. The dimensional LPE score was associated with both future general and violent offending. However, after adjustment for gender, age, and prior delinquency, these associations disappeared, with the exception of the association between the dimensional LPE score and violent offending, which remained significant even after controlling for gender, age, and prior violent offending.DiscussionIn conclusion, there seems to be evidence of a relationship between limited prosocial emotions and future offending behavior in youth with CD. This relationship, however, should not be overestimated, as there are other (static) factors (e.g. gender and prior offending behavior) that also have a strong influence on future (violent) offending behavior. Still, from a clinical point of view, a dynamic factor like prosocial emotional skills is a good focus for reducing the risk of future offending behavior. Show less
Rutten, A.X.; Vermeiren, R.R.J.M.; Bongers, I.L.; Nieuwenhuizen, C. van 2023
BackgroundWhen screening for autism spectrum disorders (ASD), the Autism Spectrum Quotient (AQ) is generally considered to be useful. Whether the AQ is also a suitable screener for ASD in juveniles... Show moreBackgroundWhen screening for autism spectrum disorders (ASD), the Autism Spectrum Quotient (AQ) is generally considered to be useful. Whether the AQ is also a suitable screener for ASD in juveniles with severe behavioral problems (SBPs) is unknown. Due to the overlap of symptoms between ASD and SBPs, particularly in juveniles low on empathy, the screening capacity of the AQ might be constrained. The aim of the present study was to investigate whether (comorbid) SBPs affect the screening capacity of the AQ. The hypothesis is that male juveniles with SBPs - but without a diagnosis of ASD - will score higher than male juveniles without both SBPs and ASD.MethodThe AQ was completed by 216 male juveniles aged 15–18 years treated at an outpatient department of child and adolescent psychiatry. The 216 participants were categorized into four groups according to a clinical diagnosis of ASD and SBPs (defined as disruptive behavior disorder and/or delinquent behavior). Using multinomial logistic regression, we investigated whether the four identified groups, based on a diagnosis of ASD and SBPs, scored differently for the total score and subscales of the AQ.ResultsParticipants in the group with ASD (ASD+) but without SBPs (SBP-) were more likely to report higher levels of autistic traits than the reference group without both ASD and SBPs (ASD-SBP-), except for the subscale on attention to detail (ASD+SBP- OR = 1.04; 95%CI = 0.98–1.11). Participants in the group with both ASD and SBPs were more likely to report higher levels for the total AQ score (ASD+SBP+ OR = 1.03; 95%CI = 1.00–1.05) and the communication subscale of the AQ (ASD+SBP+ OR = 1.18; 95%CI = 1.07–1.31) than the reference group without both ASD and SBPs.ConclusionIn outpatient male juveniles, SBPs do not affect the screening capacity of the AQ for autistic traits. In spite of the well-known overlap of symptoms between ASD and SBPs, male juveniles with SBPs but without a diagnosis of ASD do not score higher on the AQ than male juveniles without SBPs and without a diagnosis of ASD. Show less
Few studies have scrutinized the prospective relation between psychopathy and criminality in detained girls. Consequently, it is not well known if the psychopathy construct adds to the prediction... Show moreFew studies have scrutinized the prospective relation between psychopathy and criminality in detained girls. Consequently, it is not well known if the psychopathy construct adds to the prediction of recidivism over other risk factors, such as conduct disorder and past criminality. To address this research gap, the current study examined data from 302 detained girls (M age = 16.2). Psychopathy total and component (i.e., narcissism, callous-unemotional, and impulsivity) scores were derived from the self-report version of the Antisocial Process Screening Device (APSD). Latent profile analysis was used to identify girls with high scores on the three com-ponents (tentatively labeled 'putative psychopathic personality'). Five youth recidivism outcomes were measured (i.e., violent, serious non-violent, drug, total, and versatile), based on arrest charges that occurred before girls were 18 years of age. With a few exceptions, neither the ASPD total nor the APSD component scores contributed to the prediction of the recidivism outcomes. Girls with a putative psychopathic personality also were not at increased risk for recidivism. Findings overall suggest that the psychopathy construct should not be used for risk assessment purposes among detained girls, at least not when assessed via the self-report version of the APSD. Show less
Aghajani, M.; Klapwijk, E.T.; Andershed, H.; Fanti, K.A.; Wee, N.J.A. van der; Vermeiren, R.R.J.M.; Colins, O.F. 2021
Background: Reflecting evidence on Callous-Unemotional (CU) traits (e.g., lack of empathy and guilt, shallow affect), the DSM-5 added a categorical CU-based specifier for Conduct Disorder (CD),... Show moreBackground: Reflecting evidence on Callous-Unemotional (CU) traits (e.g., lack of empathy and guilt, shallow affect), the DSM-5 added a categorical CU-based specifier for Conduct Disorder (CD), labeled 'with Limited Prosocial Emotions' (LPE). Theory and prior work suggest that CD youths with and without LPE will likely differ in neural processing of negative socioemotional content. This proposition, however, is mainly derived from studies employing related, yet distinct, operationalizations of CU traits (e.g., dimensional measure/median split/top quartile), thus precluding direct examination of LPE-specific neurocognitive deficits.Methods: Employing a DSM-5 informed LPE proxy, neural processing of recognizing and resonating negative socioemotional content (angry and fearful faces) was therefore examined here among CD offenders with LPE (CD/LPE+; N = 19), relative to CD offenders without LPE (CD/LPE-; N = 31) and healthy controls (HC; N = 31).Results: Relative to HC and CD/LPEyouths and according to a linearly increasing trend (CD/LPE- < HC < CD/LPE+), CD/LPE+ youths exhibited hyperactivity within dorsolateral, dorsomedial, and ventromedial prefrontal regions during both emotion recognition and resonance. During emotion resonance, CD/LPE+ youths additionally showed increased activity within the posterior cingulate and precuneal cortices in comparison to HC and CD/LPE- youths, which again followed a linearly increasing trend (CD/LPE- < HC < CD/LPE+). These effects moreover seemed specific to the LPE specifier, when compared to a commonly employed method for CU-based grouping in CD (i.e., median split on CU scores).Conclusions: These data cautiously suggest that CD/LPE+ youths may exhibit an over-reliance on cortical neurocognitive systems when explicitly processing negative socioemotional information, which could have adverse downstream effects on relevant socioemotional functions. The findings thus seem to provide novel, yet preliminary, clues on the neurocognitive profile of CD/LPE+, and additionally highlight the potential scientific utility of the LPE specifier. Show less
Gatej, A.R.; Lamers, A.; Domburgh, L. van; Vermeiren, R. 2020
Clinical guidelines for severe behavioural problems (SBPs) in children have recently been developed in several European countries. However, questions emerged regarding their applicability to... Show moreClinical guidelines for severe behavioural problems (SBPs) in children have recently been developed in several European countries. However, questions emerged regarding their applicability to practice. Our study aimed to provide a first European insight into guidelines' fitness-for-purpose by exploring mental health clinicians' familiarity with, use and perceived value of guidelines for SBPs in children. Participants included 161 clinicians, primarily psychiatrists, from 24 countries. Clinicians completed a semi-structured qualitative questionnaire on existing SBPs guidelines and development of new guidelines where not available. Clinicians' responses were mapped against academic experts' perceptions on SBPs guidelines highlighted in a previous study (Gatej et al. in Eur Psychiatry 57:1-9, 2019). Under half of the clinicians reported being unaware of guidelines. Of these, 37.6% represented countries where guidelines were available according to experts. The remaining half of clinicians who were aware of guidelines on average reported being moderately familiar with their content, perceiving them as moderately useful and using them some of the time. Additionally, 60.8% clinicians agreed that SBPs guidelines need to be developed, as these would create a shared scientific knowledge base and common practice. Guideline improvements included taking a multifactorial approach, creating specific case recommendations, and dissemination efforts. The modest familiarity with and use of guidelines amongst practitioners may highlight guidelines poor fitness-for-purpose, or, alternatively, an underlying confusion around the meaning and purpose of guidelines. Moving forward, efforts should be directed at disseminating clearer definitions of guidelines, addressing existing challenges, and unifying efforts to further develop and audit application of international guidelines for SBPs. Show less
Gatej, A.R.; Lamers, A.; Domburgh, L. van; Crone, M.; Ogden, T.; Rijo, D.; ... ; Vermeiren, R. 2019
Individuals with autism spectrum disorder (ASD) and individuals with conduct disorder (CD) are characterized by notable impairments in social-emotional functioning. In this thesis social-emotional... Show moreIndividuals with autism spectrum disorder (ASD) and individuals with conduct disorder (CD) are characterized by notable impairments in social-emotional functioning. In this thesis social-emotional impairments were investigated using a cognitive neuroscience perspective (i.e., studying cognitive mechanisms and associated neural processes and structures). First, we directly compared groups of ASD and CD to test the hypothesized dissociable deficits in understanding other’s emotions in ASD in contrast to deficits in feeling other’s emotions in CD. This was done by comparing brain activity during basic emotion processing to assess cognitive and affective aspects of empathy, and by comparing white matter tracts that may underlie social-emotional processing. Second, we examined the neural processes at the level of social interactions in ASD and in CD, which has been overlooked by prior work, by studying interactive decision-making in response to other’s emotions. The results of the first part of this thesis show that different neural mechanisms underlie social-emotional difficulties in ASD and CD. Results of the second part imply that uncovering the neural correlates of interacting with others might lead to refined models of social-emotional deficits in ASD and CD that are different from previous accounts based on merely observing other’s emotions. Show less
The work presented in this thesis provides important new clues on the neurobiology of juvenile psychopathic traits in clinically antisocial juveniles. The data specifically shows that these... Show moreThe work presented in this thesis provides important new clues on the neurobiology of juvenile psychopathic traits in clinically antisocial juveniles. The data specifically shows that these traits are ostensibly underpinned by highly specific corticolimbic network dysfunctions, in which amygdala subregional networks seem particularly relevant. That data additionally suggests that some of these network dysfunctions and their associated neurocognitive deficits are possibly driven by alterations in the oxytocinergic system. Interestingly, the data also provides preliminary neurobiological support for the scientific utility of using juvenile psychopathic traits to subtype the highly heterogeneous group of clinically antisocial teens. While these data may represent important new steps towards a deeper understanding of clinical youth antisociality, their significance has to be evaluated by replication studies that further explore and validate the findings presented here. Show less
Aghajani, M.; Klapwijk, E.T.; Wee, N.J. van der; Veer, I.M.; Rombouts, S.A.R.B.; Boon, A.E.; ... ; Colins, O.F. 2017
Kinderen met een oppositioneel opstandige gedragsstoornis (ODD) of antisociale gedragsstoornis (CD) hebben een verhoogd risico op toekomstig probleemgedrag zoals delinquentie, werkeloosheid en... Show moreKinderen met een oppositioneel opstandige gedragsstoornis (ODD) of antisociale gedragsstoornis (CD) hebben een verhoogd risico op toekomstig probleemgedrag zoals delinquentie, werkeloosheid en psychiatrische problemen. Om beter te begrijpen waarom kinderen agressief en antisociaal gedrag vertonen en dit gedrag positief te kunnen beïnvloeden is het nuttig om naar de onderliggende cognitieve en neurobiologische processen te kijken, welke onderliggend zijn aan (probleem)gedrag. Eén van die mechanismen is zelfregulatie: het vermogen om controle uit te kunnen oefenen over onze gedachten, emoties en gedrag. In dit onderzoek hebben we zelfregulatie onderzocht door vier aspecten van zelfregulatie te onderzoeken: neurobiologie (ANS, HPA-as), emotieregulatie; executieve functies en gedrag. We onderzochten 65 jongens met ODD/CD en 38 normaal ontwikkelende controle jongens in de leeftijd van 8-12 jaar in rust en in een stressvolle situatie. We ontdekten dat jongens met ODD/CD een heterogene groep vormen zowel op gedragsniveau als neurobiologisch niveau. Daarnaast zagen we dat er specifieke relaties zijn tussen neurobiologische factoren en verschillende gedragsproblemen en dat de neurobiologie voorspellend is voor het verloop van agressie over een jaar tijd. Deze informatie is belangrijk omdat het laat zien dat interventies moeten aansluiten op het individu, passend bij het mechanisme dat onderliggend is aan het probleemgedrag en verstoord is. Show less
Colins, O.F.; Damme, L. van; Fanti, K.A.; Andershed, H. 2017
In DSM 5, conduct disorder (CD) has been expanded with a new specifier ‘with Limited Prosocial Emotions’ (LPE) in addition to the age-of-onset (AoO) subtyping, and is thought to identify a severe... Show moreIn DSM 5, conduct disorder (CD) has been expanded with a new specifier ‘with Limited Prosocial Emotions’ (LPE) in addition to the age-of-onset (AoO) subtyping, and is thought to identify a severe antisocial subgroup of CD. However, research in clinical practice has been scarce. Therefore, the current study will examine differences in clinical symptoms between subtypes of CD, based on both subtyping schemes. Subsequently, it will investigate whether the LPE specifier explains unique variance in aggression, added to the AoO subtyping. A sample of 145 adolescents with CD (51 % male, mean age 15.0) from a closed treatment institution participated in this study. CD diagnoses and AoO subtype were assessed using a structured diagnostic interview. The LPE specifier was assessed using the callous–unemotional dimension of the Youth Psychopathy Traits Inventory (YPI). Self-reported proactive and reactive aggression, rule-breaking behavior and internalizing problems within the subtypes were compared. Youth with childhood-onset CD and LPE showed significantly more aggression than adolescent-onset CD without LPE (proactive aggression: F = 3.1, p < 0.05, reactive aggression: F = 3.7, p < 0.05). Hierarchical regression revealed that the LPE specifier uniquely explained 7 % of the variance in reactive aggression, additionally to the AoO subtyping. For proactive aggression, the interaction between AoO and the LPE added 4.5 % to the explained variance. Although the LPE specifier may help to identify a more aggressive subtype of CD in adolescents, the incremental utility seems to be limited. Therefore, clinical relevance of the LPE specifier in high-risk adolescent samples still needs to be investigated thoroughly. Show less
Kersten, L.; Präzlich, M.; Mannstadt, S.; Ackermann, K.; Kohls, G.; Oldenhof, H.; ... ; Stadler, C. 2016
Background: In Europe, the number of females exhibiting oppositional defiant disorder (ODD) and conduct disorder (CD) is growing. Many of these females live in youth welfare institutions.... Show moreBackground: In Europe, the number of females exhibiting oppositional defiant disorder (ODD) and conduct disorder (CD) is growing. Many of these females live in youth welfare institutions. Consequently, there is a great need for evidence-based interventions within youth welfare settings. A recently developed approach targeting the specific needs of girls with ODD and CD in residential care is START NOW. The aim of this group-based behavioural skills training programme is to specifically enhance emotional regulation capacities to enable females with CD or ODD to appropriately deal with daily-life demands. It is intended to enhance psychosocial adjustment and well-being as well as reduce oppositional and aggressive behaviour. We present the study protocol (version 4.1; 10 February 2016) of the FemNAT-CD intervention trial titled 'Group-Based Treatment of Adolescent Female Conduct Disorders: The Central Role of Emotion Regulation'. Methods/design: The study is a prospective, confirmatory, cluster-randomised, parallel-group, multi-centre, randomised controlled trial with 128 institutionalised female adolescents who fulfil the diagnostic criteria of ODD and/or CD. Institutions/wards will be randomised either to provide the 12-week skills training as an add-on intervention or to provide treatment as usual. Once the first cycle is completed, each institution will run a second cycle with the opposite condition. Primary endpoints are the pre-post change in number of CD/ODD symptoms as assessed by a standardised, semi-structured psychiatric interview (Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime, CD/ODD section) between baseline and the end of intervention, as well as between baseline and a 3-month follow-up point. Secondary objectives include pre-post change in CD/ODD-related outcome measures, most notably emotional regulation on a behavioural and neurobiological level after completion of START NOW compared with treatment as usual. Discussion: To our knowledge, this study is the first to date to systematically investigate the effectiveness of an adapted integrative psychosocial intervention designed for female adolescents with ODD and CD in youth welfare settings. Trial registration: German Clinical Trials Register (DRKS) identifier: DRKS00007524. Registered on 18 December 2015 and with the World Health Organisation International Clinical Trials Registry Platform. Show less
Colins, O.; Vermeiren, R.; Vahl, P.; Markus, M.; Broekaert, E.; Doreleijers, T. 2012
