The present study examines whether heterogeneous groups of children identified based on their longitudinal scores on conduct problems (CP) and callous-unemotional (CU) traits differ on physiological and behavioral measures of fear. Specifically, it aims to test the hypothesis that children with high/stable CP differentiated on CU traits score on opposite directions on a fear-fearless continuum. Seventy-three participants (M age = 11.21; 45.2% female) were selected from a sample of 1,200 children. Children and their parents completed a battery of questionnaires assessing fearfulness, sensitivity to punishment, and behavioral inhibition. Children also participated in an experiment assessing their startle reactivity to fearful mental imagery, a well-established index of defensive motivation. The pattern of results verifies the hypothesis that fearlessness, assessed with physiological and behavioral measures, is a core characteristic of children high on both CP and CU traits (i.e., receiving the DSM-5 specifier of limited prosocial emotions). To the contrary, children with high/stable CP and low CU traits demonstrated high responsiveness to fear, high behavioral inhibition, and high sensitivity to punishment. The study is in accord with the principle of equifinality, in that different developmental mechanisms (i.e., extremes of high and low fear) may have the same behavioral outcome manifested as phenotypic antisocial behavior.

The present study aimed to examine whether callous-unemotional, grandiose-manipulative, and impulsive-irresponsible dimensions of psychopathy are differentially related to various affective and physiological measures, assessed at baseline and in response to violent and erotic movie scenes. Data were collected from young adults (N = 101) at differential risk for psychopathic traits. Findings from regression analyses revealed a unique predictive contribution of grandiose-manipulative traits in particular to higher ratings of positive valence for violent scenes. Callous-unemotional traits were uniquely associated with lower levels of sympathy toward victims and lower ratings of fear and sadness during violent scenes. All three psychopathy dimensions and the total psychopathy scale showed negative zero-order correlations with heart rate at baseline, but regression analyses revealed that only grandiose manipulation was uniquely predictive of lower baseline heart rate. Grandiose manipulation was also significantly associated with lower baseline skin conductance. Regarding autonomic activity, findings resulted in a unique negative association between grandiose manipulation and heart rate activity in response to violent scenes. In contrast, the impulsive-irresponsible dimension was positively related with heart rate activity to violent scenes. Finally, findings revealed that only callous-unemotional traits were negatively associated with startle potentiation in response to violent scenes. No associations during erotic scenes were identified. These findings point to unique associations between the three assessed dimensions of psychopathy with physiological measures, indicating that grandiose manipulation is associated with hypoarousal, impulsive irresponsibility with hyperarousal, and callous-unemotional traits with low emotional and fear responses to violent scenes.

Evidence from physiological studies has been integral in many causal theories of behavioral and emotional problems. However, this evidence is hampered by the heterogeneity characterizing these problems. The current study adds to prior work by identifying neuro-physiological markers associated with heterogeneity in conduct problems (CP), callous-unemotional (CU) traits, and anxiety. Participants were classified into the following groups: (a) low risk, (b) anxious (predominately high anxiety), (c) primary (scored high on CP and CU traits but low on anxiety), and (d) secondary (high anxiety, CU traits, and CP). Developmental differences were also examined by including two different samples assessed during young adulthood (Study 1: n = 88; Mage = 19.92; 50% female) and childhood (Study 2: n = 72; Mage = 5.78, SD = 1.33; 39 males). Participants in both studies were recruited from community samples (Study 1: n = 2,306; Mage = 16, SD = .89; Study 2: n = 850; Mage = 5.01, SD = .95). Physiological responses (heart rate, skin conductance, startle modulation) were recorded while children and adults watched negative affective and neutral scenes. Medial prefrontal activation (oxygenated hemoglobin) was also measured in young adults. Findings suggested that individuals in the secondary and anxious psychopathy groups showed higher physiological arousal and startle reactivity to violent, fearful, and anger stimuli compared to individuals in the primary psychopathy group. In contrast, primary and secondary psychopathy groups showed similar physiological reactions to sad stimuli assessed during childhood. Also, young adults in the primary and secondary subtypes showed lower medial prefrontal cortex activation to violent stimuli compared to the anxious group. These findings provide evidence for the value of a multidomain approach for identifying neurophysiological mechanisms that can inform prevention and treatment efforts. (PsycINFO Database Record

This study investigated whether a school-based pilot prevention program is effective in reducing Conduct Disorder (CD) symptoms and callous unemotional (CU) traits (i.e., lack of empathy and guilt) in a community sample of children. A total of 304 children from three schools in Cyprus were randomly assigned at school level to either a prevention group that received a skill building training program (N = 94; M = 7.91, SD = .74; 52.1% female) or a control group that received no training (N = 210; M = 7.82, SD = .81; 50.5% female). To evaluate the effectiveness of the program, CD symptoms and CU traits were assessed before the implementation of the training program and at 3 and 9 months after training. Additionally, the child's impulsivity, parental involvement and friend support were assessed pre- and post-prevention. Significant post-training reductions in CU traits were identified for the prevention, but not the control, group at both 3-month and 9-month follow-ups and in CD symptoms at the 9 month follow-up. Furthermore, children in the prevention group scored lower on impulsivity and higher on paternal involvement and friend support compared to the control group after participating in the training program. This study provides preliminary evidence that child focused training delivered in the school setting can provide lasting benefits by preventing the development of CU traits, impulsivity, and CD. The program was also successful in improving the child's social relationships with peers and parents. These findings emphasize the importance of school based prevention efforts.

DSM-5 added a categorically defined specifier ('with Limited Prosocial Emotions'; LPE) for the diagnosis of conduct disorder (CD). This paper systematically reviews the evidence base for this specifier in children and adolescents who are diagnosed with CD. Computer-assisted searches were executed and identified 181 potentially relevant papers. Eventually, nine papers were included in this review, referring to eight unique samples. All studies constructed an LPE measure by pulling the same items from the same rating scales that were used in the development of the DSM-5 LPE specifier. The prevalence of youth with CD who met criteria for this novel LPE specifier (CD + LPE) ranged from 6.1% to 83.7%. The studies greatly varied in the features used to test the viability of the DSM-5 LPE specifier. The most commonly used features relate to severity of antisocial behavior, low neuroticism (or lack of anxiety and depression), and treatment responsiveness. Available work altogether showed that CD + LPE youth displayed higher levels of past antisocial behaviour than CD Only youth, but failed to reveal other group differences that corroborate with expectations. Effect sizes typically were in the small to moderate range, suggesting that the practical usefulness of the group differences is limited. Empirical work shows that this specifier should not be used for clinical decision-making when relying on items from measures that have been used in the development of the LPE specifier. Crucially, limitations that hallmark the few studies on the topic hamper any firm conclusion about the usefulness of the specifier.

Medication non-adherence (MNA) constitutes a complex health problem contributing to increased economic burden and poor health outcomes. The Medication Adherence Model (MAM) supports that numerous processes are involved in medication adherence (MA). Based on the MAM and guidelines of the World Health Organization (WHO), this scoping review aimed to identify the barriers and facilitators associated with MA, and the behavioral health interventions and techniques among chronic conditions presenting with high non-adherence rates (asthma, cancer, diabetes, epilepsy, HIV/AIDS, and hypertension). PubMed, PsycINFO, and Scopus databases were screened, and 243 studies were included. A mixed methods approach was used to collate the evidence and interpret findings. The most commonly reported barriers to MA across conditions were younger age, low education, low income, high medication cost, side effects, patient beliefs/perceptions, comorbidities, and poor patient–provider communication. Additionally, digitally delivered interventions including components such as medication and condition education, motivational interviewing (MI), and reinforcement and motivational messages led to improvements in MA. This review highlights the importance of administrating multicomponent interventions digitally and personalized to the patients’ individual needs and characteristics, responding to the adherence barriers faced. This is the first review examining and synthesizing evidence on barriers and facilitators to MA and behavioral health interventions used for improving MA across chronic conditions with the highest non-adherence rates and providing recommendations to researchers and clinicians. Stakeholders are called to explore methods overcoming barriers identified and developing effective multicomponent interventions that can reduce the high rates of MNA.

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Background: Patients prescribed with medication that treats mental health conditions benefit the most compared to those prescribed with other types of medication. However, they are also the most difficult to adhere. The development of mobile health (mHealth) applications (“apps”) to help patients monitor their adherence is fast growing but with limited evidence on their efficacy. There is no evidence on the content of these apps for patients taking psychotropic medication. The aim of this study is to identify and evaluate the aims and functioning of available apps that are aiming to help and educate patients to adhere to medication that treats mental health conditions.Method: Three platform descriptions (Apple, Google, and Microsoft) were searched between October 2015 and February 2016. Included apps need to focus on adherence to medication that treats mental health conditions and use at least a reinforcement strategy. Descriptive information was extracted and apps evaluated on a number of assessment criteria using content analysis.Results: Sixteen apps were identified. All apps included self-monitoring properties like reminders and psycho-educational properties like mood logs. It was unclear how the latter were used or how adherence was measured. Major barriers to medication adherence like patients' illness and medication beliefs and attitudes were not considered nor where information to patients about mediation side effects. Very few apps were tailored and none was developed based on established theories explaining the processes for successful medication adherence like cognitions and beliefs. Reported information on app development and validation was poor.Discussion: A variety of apps with different properties that tackle both intentional and unintentional non-adherence from a different perspective are identified. An evidence-based approach and co-creation with patients is needed. This will ensure that the apps increase the possibility to impact on non-adherence. Theories like social cognition models can be useful in ensuring that patients' education, motivation, skills, beliefs, and type of adherence are taken into consideration when developing the apps. Findings from this study can help clinicians and patients make informed choices and pursue policy-makers to integrate evidence when developing future apps. Quality-assurance tools are needed to ensure the apps are systematically evaluated.