Children with callous, unemotional (CU) traits - Neurological study

A Recent study reveals that a small number of children with a 'callous' attitude towards other children and adults may be suffering from a neurological condition that pre-determines their nature.

If this is diagnosed and proven to be the case, then it will dictate the way that parents, teachers and medical practitioners deal with the child's behaviour and will determine a more focussed solution.

Background: Children with callous-unemotional (CU) traits may have a particularly malevolent view of social conflicts and a pervasive insensitivity to others’ distress.

The current study examined whether children with CU traits have unique expectations and values regarding the consequences of aggressive conflicts and a ubiquitous lack of concern for others’ feelings independent of co-occurring aggression.

Methods:  Participants were 96 (46 males, 50 females) children recruited from elementary schools within an urban city.

Associations between CU traits and child reports of outcome expectancies/values following aggressive conflicts and facets of empathy were examined after controlling for aggression, academic abilities, and demographic covariates.

Results:  Children with higher CU traits were less likely to expect that aggression would result in victim suffering and feelings of remorse.

After controlling for co-occurring aggression, children with higher CU traits were more likely to expect that aggression would result in peer dominance, while children with higher levels of aggression were more likely to expect that attacking others would reduce their aversive behaviour.

Children with higher CU traits were less concerned that aggressive behavior would result in punishment, victim suffering, and feelings of remorse.

Moreover, children with higher CU traits reported lower levels of empathetic concern and sadness in response to others’ distress outside of aggressive conflicts.

Conclusions:  Children with CU traits tend to minimize the extent to which aggression causes victim suffering and openly acknowledge caring less about distress and suffering in others.

They are less intimidated by the possibility of being punished for aggressive behavior and tend to view aggression as an effective means for dominating others.

In summary, children with CU traits have a particularly malicious social schema that may be difficult to change using conventional treatment methods.

To read the paper published in The Journal of Child Psychology and Psychiatry follow this link: Perceptions of aggressive conflicts and others’ distress in children with callous-unemotional traits: ‘I’ll show you who’s boss, even if you suffer and I get in trouble’

New Diagnostic Guidelines for DSM: The Manual for Mental Disorders

New Diagnostic Guidelines for Mental Illnesses Proposed - BusinessWeek

For the first time in more than a decade, the American Psychiatric Association has announced proposed changes to the Diagnostic and Statistical Manual of Mental Disorders (DSM), long considered the "Bible" of psychiatry.

Unlike its predecessor, DSM-4, the new DSM-5 would not formally recognize sex and Internet addictions; would create a new category for "risk" disorders for people possibly heading towards developing full psychosis or dementia; and would create a new disorder, "temper dysregulation with dysphoria" (TDD) to incorporate both mood and behavioral disturbances, partly a response to current overdiagnosis of juvenile bipolar disorder.

Other issues were also addressed, including creating an overarching category known as "autism spectrum disorders" to encompass autism, Asperger's syndrome and other similar conditions. This term is already widely used. And "mental retardation" would become "intellectually challenged."

DSM is the tome used by psychiatrists and other mental health professionals to diagnose different conditions and to guide research.

The proposed draft will be available for public comment until April 20. The final document, which has already been 10 years in the making, is expected to be released in 2013. The DSM-4 was published in 1994.

One of the major changes in the proposed volume will be a move toward "dimensional assessments" for mental disorders, meaning that strict, immutable categories will be replaced by a reliance on continuums and that "cross-cutting" symptoms -- those that span several different disorders -- will be included in the criteria.

"There's no measure in the [DSM-4] to account for the severity of the disorder and therefore no way to measure if a patient, on quantitative measures, is improving with treatment," Dr. Darrel Regier, vice chair of the DSM-5 Task Force and director of research for the American Psychiatric Association, said during a Tuesday teleconference announcing the proposed changes. "We're trying to address this with more quantitative measures on a continuum with a cut-off to decide mild, severe, very severe."

This time around, experts say they are giving "careful consideration" to how mental health disorders might vary according to race, gender and ethnicity.

Primary symptoms of psychosis may be evident in 12-year-olds

Children normally experience flights of fancy, including imaginary friends and conversations with stuffed animals, but some of them are also having hallucinations and delusions which might be the early signs of psychosis.

A study of British 12-year-olds that asked whether they had ever seen things or heard voices that weren't really there, and then asked careful follow-up questions, has found that nearly 6 percent may be showing at least one definite symptom of psychosis.

The children who exhibited these symptoms had many of the same risk factors that are known to correlate with adult schizophrenia, including genetic, social, neurodevelopmental, home-rearing and behavioral risks.

"We don't want to be unduly alarmist, but this is also not something to dismiss," said co-author Terrie Moffitt, the Knut Schmidt Nielsen professor of psychology and neuroscience and psychiatry & behavioral sciences at Duke University. The study appears in the April issue of Archives of General Psychiatry.

The children were participants in the long-term Environmental Risk Longitudinal Twin Study in Britain, which includes 2,232 children who have been tracked since age 5 and reassessed at 7, 10 and 12.

The British study is an outgrowth of research that the same group did earlier with a long-term cohort in Dunedin, New Zealand. At age 11, those children were asked about psychotic symptoms, but the researchers waited 15 years to see how, as adults, their symptoms matched what they reported at 11. By age 26, half of the people who self-reported symptoms at age 11 were found to be psychotic as adults.

"It looks like a non-trivial minority of children report these symptoms," said co-author Avshalom Caspi, the Edward M. Arnett professor of psychology and neuroscience and psychiatry & behavioral sciences at Duke.

The findings provide more clues to the development of schizophrenia, but don't solve any questions by themselves, said co-author Richard Keefe, director of the schizophrenia research group in the department of psychiatry and behavioral sciences at Duke.

Schizophrenia often goes undetected until adolescence, when the first overt symptoms -- antisocial behavior, self-harm, delusions -- begin to manifest in an obvious way. But nobody knows whether the disease is triggered by the process of adolescence itself, or brain development or hormone changes. "It's my impression that all of those things interact," Keefe said.

Psychotic symptoms in childhood also can be a marker of impaired developmental processes, and are something caregivers should look for, Moffitt said. "There is not much you can do except monitoring and surveillance," Moffitt said. "But we feel we should be alerting clinicians that there's a minority to pay attention to."

While the incidence of psychotic symptoms in this study was around 5 or 6 percent, the adult incidence of schizophrenia is believed to be about 1 percent, Keefe added. There are some recent findings however, that many more people experience hallucinations and delusions without being diagnosed as psychotic, he said.

The research was supported by the U.S. National Institutes of Health, UK Medical Research Council, The National Alliance of Research on Schizophrenia and Depression, the Health Research Board of Ireland and the William T. Grant Foundation.

Etiological and Clinical Features of Childhood Psychotic Symptoms, Guilherme Polanczyk et al, Archives of General Psychiatry, April 2010 http://archpsyc.ama-assn.org/cgi/content/full/67/4/328

Link: http://www.duke.edu/