Youths with conduct disorder and psychopathic traits are particularly difficult to treat.
Psychopathic traits are associated with two main impairments: a reduced empathic response to distress in others and impairment in reinforcement-based decision making.
The reduced empathic response to distress principally reflects a reduced amygdala response to the distress of others (their fear, sadness or pain).
The impairment in reinforcement-based decision making reflects dysfunction in the roles of the ventromedial prefrontal cortex (vmPFC) and caudate in representing expected reward and punishment and in detecting inconsistencies between obtained and expected rewards or punishments.
These two main impairments interfere with socialization, leading to the development of an individual with reduced guilt and increased probability of using instrumental antisocial behaviour to achieve their goals.
Heritability studies implicate a genetic contribution to these impairments; however, molecular genetic information on this disorder remains in its infancy.
Environmental variables that affect the development of the amygdala, vmPFC and caudate have been identified, but their role in the development of psychopathic traits has not been clearly demonstrated.
Not all youths with conduct disorder show psychopathic traits — there are individuals with a notably different pathophysiology marked by anxiety and increased responsiveness to threat.
Effective treatment of conduct disorder may require differentiating patients into those with psychopathic traits versus those with anxiety and increased responsiveness to threat and developing distinct treatment approaches for each group.
Conduct disorder is a childhood behaviour disorder that is characterized by persistent aggressive or antisocial behaviour that disrupts the child's environment and impairs his or her functioning. A proportion of children with conduct disorder have psychopathic traits. Psychopathic traits consist of a callous–unemotional component and an impulsive–antisocial component, which are associated with two core impairments. The first is a reduced empathic response to the distress of other individuals, which primarily reflects reduced amygdala responsiveness to distress cues; the second is deficits in decision making and in reinforcement learning, which reflects dysfunction in the ventromedial prefrontal cortex and striatum. Genetic and prenatal factors contribute to the abnormal development of these neural systems, and social–environmental variables that affect motivation influence the probability that antisocial behaviour will be subsequently displayed.
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This work was supported by the Intramural Research Program of the National Institute of Mental Health, National Institutes of Health, USA, under grant number 1-ZIA-MH002860-08.
The author declares no competing financial interests.
- Observational fear
The phenomenon that an infant's avoidance responses to a previously novel object are modified by the mother's apparent emotional reaction to this object. Typically, infants avoid objects associated with maternal fear.
Actions that violate norms.
- Passive avoidance learning
An experimental paradigm in which the individual learns to approach or passively avoid (by not responding to) objects that elicit either reward or punishment (for example, money gain or loss).
- Operant extinction
An experimental paradigm in which the individual learns that responding to an object is rewarding but then, after a change of reinforcement contingency, should extinguish this response as responding comes to be associated with punishment.
- Reversal learning
An experimental paradigm in which the individual initially learns to make a response towards one of a paired set of stimuli to gain reward but then, after a change of reinforcement contingency, should reverse their behaviour towards the second object as the first object comes to be associated with punishment.
- Prediction error
The difference between the amount of reward or punishment received and the amount expected.
- Expected value
The expected reward or punishment following the commission of a specific response.
- Functional anisotropy
A parameter in diffusion tensor imaging, which images brain structures by measuring the diffusion properties of water molecules. It provides information about the microstructural integrity of white-matter tracts.
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