Empathy related brain activity in psychopathic-like adolescents

Concerning:
Request for approval for an add-on study in a subsample of youths that are
recruited in the context of an already METC approved MRI study in healthy
controls, youths with conduct disorder and youths with autism spectrum disorder
(P12.063). Specifically, in the context of this add-on study, we will ask the
youths with CD who participated to this already approved study, to be
interviewed for approximately two hours.
This interview will be administered to assess psychopathic-like traits by means
of an expert based assessment (the Psychopathy Checklist-Revised: Youth
Version). Interviews will only be performed with youths who also give
permission to review their institution files. This file study is a part of the
expert based assessment as performed by means of the Psychopathy
Checklist-Revised: Youth Version. By doing so, we will be able to assess
psychopathic-traits in juvenile justice involved youths with the measure that
is considered to be the golden standard to assess the construct of psychopathy
in forensic settings.

Background:
Adolescents with high levels of psychopathic-like traits show features
typically seen in adult psychopaths. In addition, the few available
longitudinal studies on the topic suggest that psychopathic-like traits are
relatively stable during the transition from adolescence to adulthood. One
major concern of applying this construct to juveniles is that underlying traits
(e.g. selfishness) may be part of normal development. Therefore, only a
minority of children and adolescents with psychopathic-like traits will become
tomorrow*s psychopath. An intriguing issue that arises is how the reliability
of the psychopathy construct in juveniles can be improved. The current proposal
will address this question by integrating the study of social decision making
and its neurobiological correlates in normal individuals into the study of
psychopathic-like traits in adolescence. Humans do not only make social
decisions that maximize self-interest, but they also account for the well-being
of others. Recent neuroimaging studies have contributed substantially to this
insight by identifying emotion-inducing and emotion-regulating brain regions
that underlie social decision making. Given that psychopathic-like adolescents
are considered to be extremely selfish and unemotional, it is expected that the
functionality of the brain regions involved in social decision making is
different from normal population adolescents. This hypothesis will be tested by
examining brain circuitry in psychopathic-like adolescents during social
decision making tasks suited for neuroimaging.


Theoretical framework:
Researchers have begun to investigate the psychological and neural correlates
of social decisions using Game Theory. Game Theory is a collection of rigorous
models attempting to understand and explain situations in which decision-makers
must interact with one another. In general, the classical game theoretical
prediction is that individuals are selfish and driven by their own financial
interests. However, increasing evidence suggests that social decision making
may not be entirely driven by self-interest, but by cooperation, altruism and
preferences regarding the well-being of other individuals as well. Given the
personality traits ascribed to psychopathic-like adolescents (e.g. extreme
selfishness, uncooperativeness), it can be expected that psychopathic-like
adolescents will differ from normal population adolescents in social decision
making and specific brain circuitry being involved in social decision making.
Put differently, it may be that psychopathic-like adolescents make social
decisions in line with the classical game theoretical prediction.

Objectives and Hypotheses:

Objective 1: Social decision making in psychopathic-like adolescents

A recent normal population study yielded at least two important findings with
regard to social decision making in adolescence. First, when making an offer,
adolescents are most often driven by the desire to optimize self-gain, although
they also prefer to offer something rather than nothing to the other. Second,
adolescents are likely to reject an unfair offer, probably to punish the
proposer for their miserable offer. Thus, despite selfishness is relatively
normal in adolescence, adolescents already value social factors such as
fairness and cooperation. Given the personality traits ascribed to in
psychopathic-like adolescents (e.g. extreme selfishness), we generally expect
in psychopathic-like adolescents to differ in social decision making relative
to normal population adolescents. In specific, it is hypothesized that when
being a proposer in an economic game, psychopathic-like adolescents will make
more unfair offers than normal adolescents.

Objective 2: Neural correlates of social decision making in psychopathic-like
adolescents

Several cognitive and affective processes are involved in social decision
making. Studying social decision making therefore necessitates measurement and
analysis at multiple and interacting levels. Interestingly, neuroimaging
studies in normal population adults and adolescents have identified several
brain regions that are involved in social decision making. First, when dealing
with emotional and unpleasant aspects of social decision making (e.g. receiving
an unfair offer), individuals show increased activation in emotion-inducing
brain regions, such as the insula. The insula is implicated in negative
emotional states such as disgust, suggesting that emotions influence social
decision making. Second, when evaluating social decisions, individuals show
activity in emotion-regulating brain regions, such as the dorsolateral
prefrontal cortex (DLPFC) and the medial prefrontal cortex (MPFC). The DLPFC is
a region involved in cognitive control processes. Importantly, if DLPFC
activity is stronger than insula activity, than individuals can accept an
emotionally aversive offer. Thus, emotions influencing social decision making
can be overridden by cognitive control (e.g. accepting instead of rejecting an
unfair offer). The MPFC is active when individuals refer to other and their own
state of mind, or when there is a need to explain and predict the behavior of
others by attributing independent mental states (e.g. thoughts, desires). The
MPFC thus is important for integrating the perspectives of self and other. For
reasons mentioned above, we have two hypotheses. First, psychopathic-like
adolescents are less emotionally aroused when being confronted with social
decision making that is arousing for most humans. Therefore, it is hypothesized
that when proposing an unfair offer, psychopathic-like adolescents will show
less insula activity than normal population adolescents. Second,
psychopathic-like adolescents are manipulators, which require an ability of
perspective taking. However, because they are only concerned about themselves,
they may feel less need to consider the perspective of others. Therefore, we
hypothesized that, while being a proposer, psychopathic-like adolescents will
show less activity than normal population adolescents in the perspective taking
brain region (i.e. MPFC).

Previous research showed that almost all psychopathic-like adolescents meet
criteria for Conduct Disorder. Recent theories as well as the upcoming DSM-5
suggest that the small subgroup of psychopathic-like adolescents can be
identified in the broad and heterogeneous group of youths with Conduct Disorder
(Frick, 2009; Frick and Moffitt, 2010). Given our already MECT approved study
(P12.063) also include youths with Conduct Disorder and an economical game
during fMRI, we will ask all the youths with Conduct Disorder (approximately 50
youths) if they are willing to be interviewed with an assessment tool that taps
personality traits (that is, the Psychopathy Checklist-Revised: Youth Version).
For this add-on study, a new patient and/or parent information folder will be
provided, and the interview will be performed by a trained interviewer (e.g.,
the applicant of the current amendment). The Psychopathy Checklist-Revised:
Youth Version consists of an interview with the youth and a review of
collateral information such as police files, by the expert. Only youths who
give permission to review collateral information will be interviewed. The
interview will last approximately two hours, and will take place after
reviewing the collateral information. Confidentiality of the information will
be ensured, and the youth will receive a compensation of 30 euros. This
additional study will end when the already METC approved and on-going study
ends (P12.063).

not applicable