Deficits in emotion recognition and processing in children with high callous-unemotional traits: the role of the MAOA gene.

Children with high Callous-Unemotional (CU) traits show deficits in recognizing and processing facial expressions. Alterations in emotion recognition have been linked to a higher synaptic concentration of monoaminergic neurotransmitters. The current study investigated the relationship between the MAOA-Low-activity alleles and the ability to recognize and process facial expressions in 97 male children (8-12 years old) diagnosed with disruptive behavior disorder. Participants completed a computerized emotion-recognition task while an eye-tracking system recorded the number (Fixation Count, FC) and length (Fixation Duration, FD) of fixations to the eye region of the emotional stimuli. Children with high CU traits exhibited lower scores in recognition of sadness and anger, and lower FC and FD for sadness and fear than children with low CU traits. Children carrying the MAOA-Low-activity alleles displayed lower FD for sadness, and FD and FC for fear than those carrying the MAOA-High-activity alleles. These genetic effects appeared even stronger in children with CU traits. Moderation analysis revealed that CU traits were associated with lower FC and FD for fear, and lower FD for sadness, probably due to the MAOA-Low-activity alleles. Our findings, although to be replicated, suggest MAOA-Low-activity alleles as potential genetic biomarkers to identify CU children in need of training focused on emotion processing.

The "Measure of Empathy in Early Childhood": Psychometric Properties and Associations with Externalizing Problems and Callous Unemotional Traits.

Empathy is crucial to the development of socio-emotional skills in youth and empathy development is central to understanding and subtyping youth with externalizing problems. This study explored for the first time the psychometric properties of the Measure of Empathy in Early Childhood (MEEC) in a sample of 652 Italian children aged 6 to 8 years. The gender invariance of MEEC scores and their associations with other measures of empathy and prosocial behavior, and children's externalizing problems and callous-unemotional (CU) traits were also evaluated. Results indicated that with some modifications, a 5-factor structure of the Italian version of MEEC scores fitted the data and was invariant across gender. Results further supported the reliability and validity of MEEC total and subscale scores. Practical implications of these results are discussed.

The Role of Environmental Sensitivity in the Relationship Between Childhood Maltreatment and Self-Conscious Emotions of Shame and Guilt: A Brief Report.

The association between childhood maltreatment and self-conscious emotions has been proven by the literature, but with limited attention to the specific moderating mechanisms involved. Highly sensitive individuals show emotional reactivity, ease of overstimulation, which make them more influenced by childhood maltreatment experiences. The study aims to test whether environmental sensitivity moderated the link between childhood maltreatment and self-conscious emotions of shame and guilt. The sample included 128 children referred for Oppositional Defiant Disorder (M age = 9.05; SD = 1.34). Results showed a significant interaction between maltreatment and environmental sensitivity on guilt and shame (B = 1.81, SE = .84, p < .05; B = 1.69, SE = .83, p < .05): highly sensitive children presented higher levels of shame and guilt following experiences of maltreatment as compared to low sensitive children. These findings may contribute to the literature on the role of environmental sensitivity as an individual trait moderating the effect of a contextual experience.

Contemporary diagnosis and treatment of conduct disorder in youth.

INTRODUCTION: Conduct disorder (CD) is characterized by repetitive and persistent antisocial behaviors, being among the most frequently reported reasons of referral in youth. CD is a highly heterogeneous disorder, with possible specifiers defined according to age at onset, Limited Prosocial Emotions (LPE) otherwise known as Callous-Unemotional (CU) traits, Emotional Dysregulation (ED), and patterns of comorbidity, each with its own specific developmental trajectories. AREAS COVERED: The authors review the evidence from published literature on the clinical presentations, diagnostic procedures, psychotherapeutic and psychoeducational approaches, and pharmacological interventions from RCT and naturalistic studies in youth. Evidence from studies including youths with LPE/CU traits, ED and aggression are also reviewed, as response moderators. EXPERT OPINION: Due to its clinical heterogeneity, relevant subtypes of CD should be carefully characterized to gain reliable information on prognosis and treatments. Thus, disentangling this broad category in subtypes is crucial as a first step in diagnosis. Psychosocial interventions are the first option, possibly improving LPE/CU traits and ED, especially if implemented early during development. Instead, limited information, based on low-quality studies, supports pharmacological options. Second-generation antipsychotics, mood stabilizers, and stimulants are first-line medications, according to different target symptoms, such as aggression and emotional reactivity. Developmental pathways including ADHD suggest a specific role of psychostimulants.

[Conduct disorder in female adolescents: evidence from the FemNAT-CD Project.] / Il disturbo della condotta in adolescenti di sesso femminile: evidenze dal Progetto FemNAT-CD.

Conduct Disorder is a diagnosis associated with behaviors at risk for the health and development of the subject, with high social costs and with serious consequences for the adolescent's life context. This disorder is predominantly found in the male population. However, girls with Conduct Disorder often have particularly severe and pervasive symptoms, with a high psychiatric comorbidity. The purpose of this article is to summarize the objectives of the project "FemNAT-CD", in order to promote greater knowledge of the clinical characteristics of females who show a Conduct Disorder in adolescence. This paper will describe studies related to FemNAT-CD project concerning neuro-biological, neuro-cognitive and clinical characteristics of Conduct Disorder in female adolescents as well as new psychotherapeutic and pharmacological approaches.

Psychopathic Traits, Externalizing Problems, and Prosocial Behavior: The Role of Social Dominance Orientation.

Psychopathic traits in community and referred youths are strongly associated with severe externalizing problems and low prosocial behavior. However, less is known about the mechanisms that may link youth psychopathy and these outcomes. Social dominance orientation (SDO), defined as the general individual orientation toward unequal and dominant/subordinate relationships, might represent a valuable construct to explore to better understand the association between psychopathic traits, externalizing problems, and prosocial behavior. Based on this, the current study aimed to investigate the relationship between psychopathic traits, SDO, externalizing problems, and prosocial behavior in a community sample (N = 92, 45.57% females, mean age = 12.53, and SD = 0.60) and in a clinical (N = 29, 9% female, mean age = 12.57, and SD = 0.57) samples of adolescents with Oppositional Defiant Disorder or Conduct Disorder. Results showed that SDO mediated the relationship between psychopathic traits and externalizing problems and between psychopathic traits and prosocial behavior only in the clinical sample. These findings can provide valuable information on psychopathic trait correlates in youths with aggressive behavior disorders; treatment implications are discussed.

Callous-Unemotional Traits and Intelligence in Children with Externalizing Behavioral Problems.

Research on the association between callous-unemotional (CU) traits and intelligence yielded contradictory results. Moreover, several previous studies focused on global intelligence scores or verbal vs. nonverbal/performance abilities usually evaluated with short/abbreviated instruments. The current study builds on these previous works and explores the link between CU traits and intelligence using the full version of the Wechsler Intelligence Scale for Children-4th Edition (WISC-IV), which provides four different verbal and nonverbal abilities scores. This guarantees a more detailed evaluation of children's intelligence and its relation to CU traits. The sample included children (N = 149; age 6-14 years old) with severe behavioral problems. Clinicians administered the WISC-IV, and parents completed questionnaires evaluating the child's externalizing problems and CU traits. Findings showed that CU traits were associated with lower verbal comprehension scores after also controlling for gender, age, externalizing problems, and the other WISC-IV indexes. In addition, CU traits and externalizing problems did not interact in predicting the WISC-IV indexes, and there were no significant differences in the WISC-IV indexes between children with CU traits and high vs. low externalizing problems. The current study suggests the relevance of assessing and addressing verbal abilities in children with behavioral problems and CU traits.

Externalizing and Internalizing Behaviors in Children with ADHD during Lockdown for COVID-19: The Role of Parental Emotions, Parenting Strategies, and Breaking Lockdown Rules.

Lockdown experience for COVID-19 pandemic significantly affected children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD) exacerbating or promoting the onset of externalizing and internalizing symptoms. However, few studies have considered how externalizing and internalizing behaviors changed in relation to parental emotions and parenting strategies. In the present study, 992 caregivers of children and adolescents with ADHD from 5 to 18 years were presented with an online survey evaluating youths' externalizing and internalizing behaviors, their non-compliance with lockdown rules, and parental factors related to parental emotions and parenting strategies. Two hierarchical linear regression models were performed to examine the contribution of children's non-compliance with lockdown rules, parental emotions, and parenting strategies on children's externalizing and internalizing behaviors. Results revealed that externalizing behaviors were higher in children and adolescents with ADHD non-compliant with lockdown rules. Moreover, positive parenting strategies moderated the relationship between non-compliance with lockdown rules and externalizing behaviors. Differently, higher internalizing behaviors were observed in children with ADHD who had parents reporting more negative emotions and positive parenting strategies. In this case, parents' negative emotions had a moderator effect in the association between internalizing behaviors and non-compliance to lockdown measures. The clinical implications of these two different patterns of relations are discussed.

Internet Gaming Disorder in Children and Adolescents with Attention Deficit Hyperactivity Disorder.

Although Attention Deficit Hyperactivity Disorder (ADHD) has been related to an increased risk for behavioral addictions, the relationship between ADHD and Internet Gaming Disorder (IGD) is still debated. The aim of this study is to address this topic by exploring the prevalence of IGD in a consecutive sample of ADHD youth, compared to a normal control group, and by assessing selected psychopathological and cognitive features in ADHD patients with and without IGD. One hundred and eight patients with ADHD (mean age 11.7 ± 2.6 years, 96 males) and 147 normal controls (NC) (mean age 13.9 ± 3.0 years, 114 males) were included in the study and received structured measures for IGD. In the ADHD group, 44% of the sample were above the IGD cut-off, compared to 9.5% in the NC group. ADHD patients with IGD presented with greater severity and impairment, more severe ADHD symptomatology, more internalizing symptoms, particularly withdrawal/depression and socialization problems, and more prominence of addiction and evasion dimensions. A binary logistic regression showed that the degree of inattention presented a greater weight in determining IGD. These findings may be helpful for identifying, among ADHD patients, those at higher risk for developing a superimposed IGD.

Acute Tolerability of Methylphenidate in Treatment-Naïve Children with ADHD: An Analysis of Naturalistically Collected Data from Clinical Practice.

OBJECTIVES: The acute tolerability of methylphenidate (MPH) in children with attention-deficit/hyperactivity disorder (ADHD) has been studied mainly in research samples. Taking advantage of the mandatory test-dose procedure required for starting MPH in Italy, this study aimed to assess the incidence of intolerable adverse events after initial exposure to MPH in routine clinical practice. METHODS: The medical records of 480 consecutively treated, previously drug-naïve children and adolescents with ADHD (90% male, mean age 10.6 ± 3.0 years) were retrospectively analyzed. All children received an initial single dose of MPH immediate release (5 or 10 mg) followed by a 4-hour direct medical observation. Heart rate and blood pressure were measured at dosing and 1, 2, and 3 hours afterwards. If the first dose was well tolerated, the child continued treatment with MPH 5-20 mg daily, and was reassessed a week later. RESULTS: Eleven patients (2.3%, 95% CI 1.1-4.1) interrupted treatment within a week of initiation because of the following adverse events: irritability (n = 3), tics worsening (n = 3), reduced appetite (n = 1), enuresis (n = 1), hallucinations (n = 1), hyperfocus (n = 1), and 'rebound' behavioral worsening (n = 1). The most common adverse events were reduced appetite (20%), irritability (14.2%), headache (10.6%), sleep problems (9.4%), stomachache (9.4%), and tics (5%). Intellectual disability increased the risk of any adverse event in general and of irritability in particular. No cardiovascular symptom was clinically reported. However, routine assessments of vital signs during the first 3 hours after the first dose of MPH showed that 9% of the children had a 20% increase in heart rate, 8.8% had a 20% increase in diastolic blood pressure and 4.5% had a 20% increase in systolic blood pressure. Of these, 25.2% still had an elevated heart rate 1 week later. CONCLUSIONS: Among stimulant-naïve children in clinical practice, the incidence of acute MPH intolerance can be estimated to be between 1.2 and 4.1%. An asymptomatic elevation in cardiovascular parameters can be observed in about 1 out of 10 children and warrants monitoring during ongoing treatment.

Parenting practices and dysregulation profile in a sample of Italian children.

BACKGROUND: emotional dysregulation is a transdiagnostic factor linked to a heightened risk for psychopathology. A dysregulation profile (DP) derived from the Strenght and Difficulties Questionnaire (SDQ) is often used to indirectly assess emotional dysregulation in children and adolescents. Theoretical models account for parenting as a causal and maintaining factor for emotional dysregulation. Notwithstanding, empirical data are scant. METHODS: 547 students (47.5% males) aged between 9 and 11 years of age (mean age = 9.66, SD = 0.64) were assessed with the SDQ-DP (teacher and parent-reported) and their parents self-reported on their own parenting practices with the Alabama Parenting Questionnaire. RESULTS: as expected, SDQ-DP teacher-rated was positively associated with maternal and paternal negative parenting practices; SDQ-DP mother and father-rated were both negatively associated with maternal and paternal positive parenting and positively associated with maternal and paternal negative parenting practices. LIMITATION: the age range is limited to pre-adolescents. The cross-sectional nature of the study precludes inferences on causality. CONCLUSIONS: youth's emotional dysregulation is linked to parenting practices. These findings support the need to include families in the intervention for emotionally dysregulated youths.

Parenting practices moderate the link between attention to the eyes and callous unemotional traits in children with Disruptive Behavior Disorder: An eye-tracking study.

Callous-unemotional (CU) traits are associated with gaze pattern deficits in youths, though it has not yet been explored if environmental factors could influence this relationship. Since parenting can influence both CU traits and children's emotion processing, the current study sought to test whether parenting moderated the relation between gaze pattern deficits and CU traits in a sample of children with Disruptive Behavior Disorder. The sample included 92 boys (aged 7-12 years) with Conduct Disorder (N = 12) and Oppositional Defiant Disorder (N = 80). All children completed a task, during which they were presented with 24 images depicting happy, sad, fearful, disgusted, angry, and neutral facial expressions. Gaze pattern has been recorded throughout the task with an eye-tracker. Positive parenting moderated the association between CU traits and first fixation duration to the eyes of facial expressions depicting negative emotions. Negative parenting moderated the association between CU traits and fixation count and fixation duration to the eyes of negative emotions. Negative parenting along with reduced attention to emotional cues (i.e., eyes) may identify a group of youths with Disruptive Behavior Disorder diagnosis at risk for severe outcomes.

Psychometric Properties of the Strengths and Difficulties Questionnaire-Dysregulation Profile in Italian Early Adolescents.

Emotional dysregulation is of great cause for concern because it is associated with severe outcomes. Currently, the identification of youths with signs of emotional and behavioral dysregulation is obtained through the assessment of a Dysregulation Profile (DP), including the Strengths and Difficulties Questionnaire-DP (SDQ-DP). Despite its increasingly frequent use in research, studies exploring the SDQ-DP properties are still limited, and no study with Italian samples is currently available. The current study aimed to explore the psychometric properties of the SDQ-DP parent-report and its association with difficulties in the school context in a sample of 332 Italian early adolescents. Results showed that the SDQ-DP parent-report is a single-factor measure with good internal consistency. Also, in both males and females, the SDQ-DP parent-report was associated with higher teacher-reported Internalizing (e.g., anxious symptoms) and Externalizing Problems (e.g., hyperactivity, conduct problems) and lower Prosocial Behavior. This study added further evidence about the utility of the SDQ-DP in the assessment, prevention, and treatment of emotional dysregulation.

Biological Bases of Empathy and Social Cognition in Patients with Attention-Deficit/Hyperactivity Disorder: A Focus on Treatment with Psychostimulants.

In recent years, there has been growing interest in investigating the effect of specific pharmacological treatments for ADHD not only on its core symptoms, but also on social skills in youths. This stands especially true for ADHD patients displaying impulsive aggressiveness and antisocial behaviors, being the comorbidity with Disruptive Behavior Disorders, one of the most frequently observed in clinical settings. This systematic review aimed to synthesize research findings on this topic following PRISMA guidelines and to identify gaps in current knowledge, future directions, and treatment implications. Search strategies included the following terms: ADHD; methylphenidate and other ADHD drugs; empathy, theory of mind and emotion recognition. Full-text articles were retrieved and data from individual studies were collected. Thirteen studies were finally included in our systematic review. Ten studies assessing changes in empathy and/or theory of mind in patients with ADHD treated after pharmacological interventions were identified. Similarly, seven partially overlapping studies assessing changes in emotion recognition were retrieved. Despite a great heterogeneity in the methodological characteristics of the included studies, most of them reported an improvement in emphatic and theory of mind abilities in youths with ADHD treated with psychostimulants and nonstimulant drugs, as well as positive but less consistent results about emotion recognition performances.

Validation of the Proposed Specifiers for Conduct Disorder (PSCD) Scale in a Sample of Italian Students.

This study aimed to further validate the self-reported version of the Proposed Specifiers Conduct Disorder (PSCD) scale, testing the associations between the PSCD with a scale that measures emotional/behavioral difficulties and prosocial behaviors (Strength and Difficulties Questionnaire, SDQ). A total of 536 Italian students (47.76% male; 11-14 years) completed the PSCD, while their caregivers and teachers completed the SDQ. A series of confirmatory factor analyses to test the best fitting model were run. The internal consistency of the PSCD was evaluated, and the correlations between the PSCD self-reported scores and SDQ Parent and Teacher report scores were examined. A bi-factor model was fitted with a refined 19-item version of the scale, which showed adequate fit indices. The PSCD total score was strongly associated with higher parent- and teacher-rated conduct problems, hyperactivity, and lower prosocial behavioral symptoms. In conclusion, this study indicated that the self-report PSCD shows preliminary promise as a reliable, easy-to-use tool, for measuring psychopathic traits in Italian children and young adolescents.

One Year Follow Up Efficacy of the Coping Power Universal and Its Relations with Teachers' Occupational Stress.

The coping power universal (CPU) is an evidence-based universal prevention program delivered by teachers, and completely integrated into the school agenda. Previous studies have shown its positive effects, though little is known about its longer-term effects, and no previous study has explored whether teachers' occupational stress could influence the CPU efficacy. The current study aimed to explore the 1 year follow up of the CPU on students' externalizing and internalizing problems and prosocial behavior, and the influence of baseline levels of teachers' stress in a sample of 316 3rd graders and their teachers (N = 32). Results showed that the CPU led to positive effects, not attainable with the standard curriculum. Additionally, improvements in prosocial behavior persisted even one year after the conclusion of the program. However, improvements in internalizing and externalizing problems were not maintained at the follow up, highlighting the need to understand the factors influencing the CPU efficacy. In this regard, our findings showed that high levels of teachers' occupational stress predicted poorer improvements following the CPU, and an increase in students' difficulties at the follow-up assessment. Addressing teachers' stress as part of prevention programs for students could boost their efficacy and yield more lasting results.

At-risk early adolescents profiles in the community: A cluster analysis using the strengths and difficulties questionnaire.

Early adolescence, with its several changes and demands, represents a delicate period of life. Several studies highlighted that during early adolescence, emotional and behavioral problems tend to increase. Using a person-centered approach, the present study explored the emotional and behavioral functioning profiles in a sample of Italian preadolescent students. Participants were 2959 youths (1533 males and 1426 females; age 10-14 years); they completed the Strengths and Difficulties Questionnaire (SDQ) and the Inventory of Callous Unemotional traits (ICU). Findings revealed four different profiles: "no psychopathology" (41.5%), "low psychopathology with sub-threshold hyperactivity" (33%), "predominantly internalizing" (19%), and "predominantly externalizing" (6.5%). The two latter clusters are characterized by high levels of SDQ Total Score. The "predominantly internalizing" is distinguished by a higher prevalence of females, and the "predominantly externalizing" by a higher prevalence of males and higher CU traits. A person-oriented approach allowed for identifying subgroups of early adolescents who may significantly vary in their configuration of internalizing and externalizing problems. Such subgroups may reflect youths for whom the creation of prevention and intervention programs could be more tailored.

The Relation of Callous-Unemotional Traits and Bullying in Early Adolescence Is Independent from Sex and Age and Moderated by Conduct Problems.

In youths, callous-unemotional (CU) traits and conduct problems (CP) are independently associated with bullying perpetration and these effects are also observed when controlling for sex. Moreover, research indicates that the co-existence of high levels of both CU and CP further increase the risk. Although several studies have examined the relationship between CU traits and traditional bullying, few have also included a measure of cyberbullying and very few of them have focused the early adolescence. The aim of this study was to replicate and extend these findings in a large sample of Italian early adolescents considering both traditional and cyberbullying behaviors. Data were extracted from the Bullying and Youth Mental Health Naples study (BYMHNS) which included 2959 students of 10-15 years of age. CP, CU traits, traditional bullying behaviors, and cyberbullying behaviors were assessed by multi-item self-report scales. As expected, we replicated the significant and specific association between CU traits and traditional bullying, extending the findings to cyberbullying. In addition, in the latter case the effect was moderated by CP. The theoretical and clinical implications of these results were discussed.

Treatment with Methylphenidate Improves Affective but Not Cognitive Empathy in Youths with Attention-Deficit/Hyperactivity Disorder.

BACKGROUND: Beside the core symptoms, patients with attention-deficit/hyperactivity disorder (ADHD) frequently show relevant difficulty in developing relationships with peers. Although ADHD symptoms may account for social impairment, deficits in cognitive and/or affective empathy have also been involved. Our aim was to investigate the effect of methylphenidate (MPH) treatment on affective and cognitive empathy. METHODS: Sixty-one drug-naïve youths with ADHD (age range 6 to 17 years, mean 10.3 ± 2.8 years, 51 males) naturalistically treated with MPH monotherapy were followed up for 6 months for ADHD symptoms and empathy, measured with the Basic Empathy Scale. RESULTS: After being treated with MPH, the patients showed a significant improvement in affective and cognitive empathy scores. Linear regression models showed that changes in inattention symptoms predicted changes in affective but not in cognitive empathy, while changes in the hyperactivity/impulsivity symptoms did not predict changes in affective or cognitive empathy. CONCLUSIONS: Our study provides a further contribution for a better understanding of the possible effects of the MPH on youth's characteristics.

Phantom Phone Signal: why it should be of interest for psychiatry.

Phantom Phone Signal (PPS) refers to the false perception of a mobile phone ringing, vibrating and blinking, when in fact it did not. A recent literature about PPS is growing, parallel to an increasing interest about its possible psychopathological implications. The present review aims to synthesize the current knowledge about the phenomenon, and to present a conceptual framework that integrates PPS as a putative index of psychopathology. Furthermore, we propose possible directions for further research. The phenomenon seems highly prevalent, irrespective of age and gender, although estimates are still inconsistent. We have analysed possible factors associated to PPS, disentangling them in person-related (i.e. characteristics of individuals who experience PPS) and phone use-related factors (i.e., time spent using the phone, time of the mobile in vibrating mode, the carrying location of the device, average number of call/message in a day, etc). Literature regarding the association between PPS and mental illness is limited, as most of the samples are not clinical and too sectorial. Preliminary data suggest that anxiety/depression and stress-related problems seem to be the psychopathological background favouring the experience of PPS. Despite PPS is a common phenomenon, it usually do not seem to significantly impact the people's quality of life. However, they deserve attention, given the huge diffusion of phone mobiles, particularly in children and adolescents, as it may be an index for emotional or stress-related difficulties. Future studies are needed to better clarify its frequency and its possible impact on everyday life. Studies in clinical samples may further clarify its psychopathological implications.