Distinguishing Youth with Conduct Disorder with Callous-Unemotional Traits using Cardiovascular Psychophysiology During Virtual Reality Fear Induction: Testing for Sex Differences

摘要： 行为障碍（CD）是影响我们年轻人的最普遍和最令人衰弱的精神疾病之一。 不幸的是，裁谈会的影响并不局限于这些早年。患有CD的青少年更容易发展 终身的精神和身体健康问题，这就是为什么CD负责575万年的健康 生命损失有混合证据支持CD治疗的有效性，这可能是因为 患有CD的青少年有不同的病因机制。研究表明， 青年与CD，与亚组的CD青年显示更严重的行为和人格症状，称为 冷酷无情（callous-unemotional，CU）CU特征是CD的一个说明符，它指定了一个高风险的青年群体， 长期从事暴力和犯罪行为，给家庭和社会带来沉重负担。关键 不同之处在于，这些青年表现出明显的个性症状，而目前的CD干预措施并不具备这些特征 治疗，如对他人麻木不仁，缺乏同情心和内疚，他们的有害行为， 肤浅/减少的影响。理解CU特征背后的机制对于装备 干预措施与知识需要采用有针对性的方法来治疗CU性状。长期 理论表明，无畏是CU特征发展的关键机制。然而，生物 支持CU特征和无畏之间联系的证据是不足的，目前的状况是， 由于生态有效性，考试受到限制。我们将研究恐惧与 和CU性状在青年（13-17岁）与CD通过测量交感神经（射血前期）， 沉浸在尖端虚拟环境中时的副交感神经系统反应性（呼吸性窦性心律不齐） 现实（VR）恐惧感应。我们将同时应用面部肌电图来评估阳性和 负原子价我们还将确定这些关联中的性别差异，并提供以下证据： 生物学恐惧特征如何在青少年时期的12个月内对CU特征的稳定性做出贡献。 该提案的潜在好处很大。根据我们的试点数据，我们将测试我们的假设， 具有CU特征的人会表现出一种独特的生物学特征，这种特征无法用无畏来解释， 关联是性别特异性的。在青年CD患者中证实这一发现可能会重塑先前的发育 CU性状的理论，可能导致改善筛选和更有利的性别反应治疗 我们的青年战略。

ABSTRACT: Conduct disorder (CD) is one of the most prevalent and debilitating psychiatric disorders impacting our youth. Unfortunately, the effects of CD are not limited to these early years. Youth with CD are more likely to develop lifelong mental and physical health problems, which is why CD is responsible for 5.75 million years of healthy life lost. There is mixed evidence supporting the effectiveness of treatment for CD, and this may be because youth with CD have differing etiological mechanisms. Research has shown that there is heterogeneity among youth with CD, with a subgroup of CD youth displaying more severe behavioral and personality symptoms, called callous-unemotional (CU) traits. CU traits is a specifier for CD that designates a high-risk group of youth who engage in chronic violence and criminal behavior, placing a significant burden on families and society. The key distinction is that these youth show distinct personality symptoms that current CD interventions are not equipped to treat, such as callousness towards others, lack of empathy and guilt for their harmful behaviors, and shallow/diminished affect. Understanding the mechanisms behind CU traits is essential for equipping interventions with the knowledge needed to employ a targeted approach for treating CU traits. Longstanding theories suggest that fearlessness is a key mechanism in the development of CU traits. However, biological evidence supporting the association between CU traits and fearlessness is deficient, and the current state of this examination has been restricted because of ecological validity. We will examine the association between fear and CU traits in youth (13-17 years) with CD by measuring sympathetic (pre-ejection period) and parasympathetic nervous system reactivity (respiratory sinus arrhythmia) during immersion in cutting edge virtual reality (VR) fear induction. We will concurrently apply facial electromyography to assess levels of positive and negative valence. We will also determine sex differences in these associations, as well as provide evidence of how biological fear profiles contribute to the stability of CU traits over 12 months during the adolescent period. The potential benefits of the proposal are high. Based on our pilot data, we will test our hypothesis that youth with CU traits will display a unique biological profile to fear that cannot be explained by fearlessness, and these associations are sex-specific. Confirming this finding in youth with CD may lead to reshaping prior developmental theories of CU traits that could lead to improved screening and more favorable gender-responsive treatment strategies for our youth.