A systematic review of the association between parental empathic capacities and externalising behaviour in childhood

Background: Childhood externalising behaviour disorders - such as Conduct Disorder, Oppositional Defiant Disorder, and Attention Deficit-Hyperactivity Disorder – present elevated risk for adverse social, health and educational outcomes and are associated with lower levels of empathy and pro-social behaviour. Empathy develops through exposure to specific parenting behaviours, such as warmth. There is evidence that parental empathy and reflective function are associated with increased pro-social behaviours in children. However, the relationship between these parental “empathic capacities” of warmth, reflective function and empathy and childhood externalising behaviour during middle childhood (6-12 years) is not clear.Methods: The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and pre-registration of the protocol on the Prospective Register of Systematic Reviews (PROSPERO) online database (registration reference CRD42022314279). Electronic databases were queried (Medline, PsychINFO and Scopus) using selected search terms, and studies were selected after their evaluation against inclusion and exclusion criteria, followed by data extraction and quality assessment by two independent raters. A narrative synthesis of the findings of selected studies was produced.Results: The review identified thirteen studies for inclusion, with a total of 8748 parent, and 9399 child participants. These comprised nine cross-sectional studies, three case-control studies, and one longitudinal study. Of these, childhood externalising behaviour was reported in relation to parental measures of warmth (nine studies), empathy (two studies), and reflective capacity (two studies). Externalising behaviour was negatively associated with warmth in five out of the nine studies (effect size: small [n=2]; medium [n=2]; large [n=1]; reflective function in both the studies (effect sizes moderate to large); and empathy in both the studies (small effect size [n=2]). Four studies did not report any significantassociations between parent and child variables. Several studies reported effects moderated by gender with stronger associations between index variables reported in males parent child dyads.Conclusion: This review provides evidence that in middle childhood lower parental empathic capacities are associated with increased levels of externalising behaviour. Future research examining the efficacy of parenting interventions that specifically target increasing warmth, reflective function and empathy may elucidate this relationship further, and probing causality may be an important next step. For instance, such studies may help to identify whether additional attachment theory-based content in current evidence-based parenting interventions improves empathic capacities and/or child behavioural outcomes. The gender effects reported in this review support an important role of fathers in theprevention and treatment of externalising behaviours. The findings of this review may inform service development around parenting interventions generally, and in those targeting at risk populations.</div

Differences between psychopathy and other personality disorders:evidence from neuroimaging

SummaryICD-10 and DSM-IV-TR diagnostic guidelines do not list psychopathy as a distinct psychiatric entity. However, there are significant overlaps between psychopathy and DSM-IV-TR Cluster B personality disorders. Neuroimaging studies implicate deficits in structure and function of frontal and limbic regions in this group of personality disorders, while highlighting both distinctions and overlaps between syndromes. Here, these data are reviewed and implications for diagnosis and clinical practice are discussed.</jats:p

Early childhood deprivation is associated with alterations in adult brain structure despite subsequent environmental enrichment

Early childhood deprivation is associated with higher rates of neurodevelopmental and mental disorders in adulthood. The impact of childhood deprivation on the adult brain and the extent to which structural changes underpin these effects is currently unknown. To investigate these questions, we utilized MRI data collected from young adults, who were exposed to severe deprivation in early childhood in the Romanian orphanages of the Ceaușescu era and then subsequently adopted by UK families. 67 Romanian adoptees (with between 3-41 months of deprivation) were compared to 21 non-deprived UK adoptees. Romanian adoptees had substantially smaller total brain volumes (TBV) than non-deprived adoptees (8.6% reduction) and TBV was strongly negatively associated with deprivation duration. This effect persisted after covarying for potential environmental and genetic confounds. In whole-brain analyses, deprived adoptees showed lower right inferior frontal surface area and volume, but greater right inferior temporal lobe thickness, surface area, and volume than the non-deprived adoptees. Right medial prefrontal volume and surface area were positively associated with deprivation duration. No deprivation-related effects were observed in limbic regions. Global reductions in TBV statistically mediated the observed relationship between institutionalization and both lower IQ and higher levels of attention-deficit/hyperactivity disorder symptoms. The deprivation-related increase in right inferior temporal volume appeared to be compensatory, as it was associated with lower levels of attention-deficit/hyperactivity disorder symptoms. We provide compelling evidence that time-limited severe deprivation in the first years of life is related to alterations in adult brain structure, despite extended enrichment in adoptive homes in the intervening years

A whole-brain investigation of white matter microstructure in adolescents with conduct disorder

<div><p>Background</p><p>The biological basis of severe antisocial behaviour in adolescents is poorly understood. We recently reported that adolescents with conduct disorder (CD) have significantly increased fractional anisotropy (FA) of the uncinate fasciculus (a white matter (WM) tract that connects the amygdala to the frontal lobe) compared to their non-CD peers. However, the extent of WM abnormality in other brain regions is currently unclear.</p><p>Methods</p><p>We used tract-based spatial statistics to investigate whole brain WM microstructural organisation in 27 adolescent males with CD, and 21 non-CD controls. We also examined relationships between FA and behavioural measures. Groups did not differ significantly in age, ethnicity, or substance use history.</p><p>Results</p><p>The CD group, compared to controls, had clusters of significantly greater FA in 7 brain regions corresponding to: 1) the bilateral inferior and superior cerebellar peduncles, corticopontocerebellar tract, posterior limb of internal capsule, and corticospinal tract; 2) right superior longitudinal fasciculus; and 3) left cerebellar WM. Severity of antisocial behavior and callous-unemotional symptoms were significantly correlated with FA in several of these regions across the total sample, but not in the CD or control groups alone.</p><p>Conclusions</p><p>Adolescents with CD have significantly greater FA than controls in WM regions corresponding predominantly to the fronto-cerebellar circuit. There is preliminary evidence that variation in WM microstructure may be dimensionally related to behaviour problems in youngsters. These findings are consistent with the hypothesis that antisocial behaviour in some young people is associated with abnormalities in WM ‘connectivity’.</p></div

Anatomy of the dorsal default-mode network in conduct disorder:Association with callous-unemotional traits

We recently reported that emotional detachment in adult psychopathy was associated with structural abnormalities in the dorsal 'default-mode' network (DMN). However, it is unclear whether these differences are present in young people at risk of psychopathy. The most widely recognised group at risk for psychopathy are children/adolescents with conduct disorder (CD) and callous-unemotional (CU) traits. We therefore examined the microstructure of the dorsal DMN in 27 CD youths (14-with/13-without CU traits) compared to 16 typically developing controls using DTI tractography. Both CD groups had significantly (p < 0.025) reduced dorsal DMN radial diffusivity compared to controls. In those with diagnostically significant CU traits, exploratory analyses (uncorrected for multiple comparisons) suggested that radial diffusivity was negatively correlated with CU severity (Left: rho = -0.68, p = 0.015). These results suggest that CD youths have microstructural abnormalities in the same network as adults with psychopathy. Further, the association with childhood/adolescent measures of emotional detachment (CU traits) resembles the relationship between emotional detachment and network microstructure in adult psychopaths. However, these changes appear to occur in opposite directions - with increased myelination in adolescent CD but reduced integrity in adult psychopathy. Collectively, these findings suggest that developmental abnormalities in dorsal DMN may play a role in the emergence of psychopathy

The impact of childhood deprivation on adult neuropsychological functioning is associated with ADHD symptom persistence

BackgroundInstitutional deprivation in early childhood is associated with neuropsychological deficits in adolescence. Using 20-year follow-up data from a unique natural experiment-the large-scale adoption of children exposed to extreme deprivation in Romanian institutions in the 1980s-we examined, for the first time, whether such deficits are still present in adulthood and whether they are associated with deprivation-related symptoms of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD).MethodsAdult neuropsychological functioning was assessed across five domains (inhibitory control, emotion recognition, decision-making, prospective memory and IQ) in 70 previously institutionalized adoptees (mean age = 25.3, 50% female) and 22 non-deprived UK adoptees (comparison group, mean age = 24.6, 41% female). ADHD and ASD symptoms were assessed using parent-completed questionnaires.ResultsEarly institutionalization was associated with impaired performance on all tasks in adulthood. Prospective memory deficits persisted after controlling for IQ. ADHD and ASD symptoms were positively correlated. After controlling for ASD symptoms, ADHD symptoms remained associated with deficits in IQ, prospective memory, proactive inhibition, decision-making quality and emotion recognition. ASD symptoms were not independently associated with neuropsychological deficits when accounting for their overlap with ADHD symptoms. Multiple regression analysis revealed that the link between childhood deprivation and adult ADHD symptoms was statistically explained by deprivation-related differences in adult IQ and prospective memory.ConclusionsThese results represent some of the most compelling evidence to date of the enduring power of early, time-limited childhood adversity to impair long-term neuropsychological functioning across the lifespan-effects that are linked specifically to deprivation-related adult ADHD symptoms.</p

The impact of childhood deprivation on adult neuropsychological functioning is associated with ADHD symptom persistence

Background: Institutional deprivation in early childhood is associated with neuropsychological deficits in adolescence. Using 20-year follow-up data from a unique natural experiment – the large-scale adoption of children exposed to extreme deprivation in Romanian institutions in the 1980s –we examined, for the first time, whether such deficits are still present in adulthood and whether they are associated with deprivation- related symptoms of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Methods: Adult neuropsychological functioning was assessed across five domains (inhibitory control, emotion recognition, decision-making, prospective memory and IQ) in 70 previously-institutionalized adoptees (mean age= 25.3, 50% female) and 22 non-deprived UK adoptees (comparison group, mean age= 24.6, 41% female). ADHD and ASD symptoms were assessed using parent-completed questionnaires. Results: Early institutionalization was associated with impaired performance on all tasks in adulthood. Prospective memory deficits persisted after controlling for IQ. ADHD and ASD symptoms were positively correlated. After controlling for ASD symptoms, ADHD symptoms remained associated with deficits in IQ, prospective memory, proactive inhibition, decision-making quality and emotion recognition. ASD symptoms were not independently associated with neuropsychological deficits when accounting for their overlap with ADHD symptoms. Multiple regression analysis revealed that the link between childhood deprivation and adult ADHD symptoms was statistically explained by deprivation-related differences in adult IQ and prospective memory. Conclusions: These results represent some of the most compelling evidence to date of the enduring power of early, time-limited childhood adversity to impair long-term neuropsychological functioning across the lifespan – effects that are linked specifically to deprivation-related adult ADHD symptoms