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

摘要： 品行障碍(CD)是影响我们年轻人的最普遍和最衰弱的精神障碍之一。 不幸的是，CD的影响并不局限于这些早年。患有CD的年轻人更有可能发展为 终生精神和身体健康问题，这就是为什么CD导致575万年的健康 失去了生命。有混合的证据支持CD治疗的有效性，这可能是因为 青年CD有不同的发病机制。研究表明，它们之间存在着异质性。 患有CD的青年，CD青年的一个亚组表现出更严重的行为和人格症状，称为 冷酷无情(CU)特征。CU特征是CD的一个指定符，它指定了一组高危青年 长期从事暴力和犯罪行为，给家庭和社会造成重大负担。钥匙 区别在于，这些年轻人表现出明显的人格症状，表明目前的CD干预措施没有配备 治疗，如对他人冷酷无情，缺乏同理心和对其有害行为的负罪感，以及 浅的/减弱的影响。了解CU特征背后的机制对于装备 采用有针对性的方法治疗CU特征所需的知识的干预。由来已久 理论认为，无畏是CU特质发展的关键机制。然而，生物的 支持CU特征和无畏之间联系的证据是不足的，这一点的现状 由于生态有效性的原因，考试受到了限制。我们将研究恐惧之间的联系 通过测量交感神经(射血前期)和CU特征对13-17岁的CD青年进行研究 尖端虚拟沉浸时的副交感神经系统反应性(呼吸性窦性心律失常) 现实(VR)恐惧诱导。我们将同时应用面部肌电图来评估阳性和 负价态。我们还将确定这些关联中的性别差异，并提供证据 在青春期的12个月中，生物恐惧特征如何有助于CU特征的稳定性。 这项提议的潜在好处很高。基于我们的试点数据，我们将检验我们的假设 CU的特征将表现出一种独特的生物特征，这是无畏无法解释的，而这些 联想是特定于性别的。在患有CD的青少年中证实这一发现可能会重塑先前的发育 CU特征理论可能导致更好的筛查和更有利的性别反应治疗 为我们的年轻人制定战略。

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.