Behavioural and Neuropsychiatric Aspects of Transition to Severe Conduct Disorder In Adolescence.

品行障碍是澳大利亚社会通过精神健康和法医系统直接付出的巨大代价，也是通过与其他精神健康问题、人际关系问题、社交功能受损和药物使用问题相关的间接代价。以行为家庭为基础的治疗在有合作父母的幼儿中有很好的成功率，然而，尽管如此，也有少数人进展为慢性问题。在儿童早期确定慢性模式的风险和复原力因素是早期干预的关键。在之前的研究中，这个研究小组首次表明，冷酷无情的特征是慢性精神病的一种特征，可以在4岁的儿童身上进行测量，并预测一系列负面结果。然而，研究还发现，行为问题儿童在青春期之前并不存在精神变态的关键神经精神病学标志，包括奖惩不敏感和情感共鸣缺陷。在青春期左右，认知-情感处理方式似乎发生了重要的变化，这与成人形式的精神变态和反社会行为有关。因此，这项研究提出了关于从童年到青春期严重反社会行为(或精神变态)发展的关键问题。我们的证据表明，青春期早期可能是代表慢性风险的内部心理特征具体化的时期。目前的研究将首次绘制出儿童-青春期后期严重反社会过程的共同神经精神标记物(情感移情、惩罚不敏感)的发展图。这一发现将对反社会行为模式和处理行为问题儿童和青少年的临床方法产生明确的影响。

Conduct disorder represents an enormous cost to Australian society directly via the mental health and forensic systems, and indirect costs via its associations with other mental health problems, relationship problems, impaired social functioning, and substance use problems. Behavioural-family-based treatment have good success rates with young children with cooperative parents, however, there are a minority who progress to chronic problems despite this. Risk and resilience factors identifying chronic patterns in early childhood are the key to early intervention. In previous research, this research team showed for the first time that callous-unemotional traits, a feature of chronic psychopathy, could be measured in children as young as 4 years, and was predictive of a range of negative outcomes. However, it was also found that the key neuropsychiatric markers characteristic of psychopathy, including reward dominance-punishment insensitivity and deficits in affective empathy, did not exist in conduct problem children prior to adolescence. Around the time of puberty, it appears that important changes occur in cognitive-affective processing styles that are associated with the adult form of psychopathy and antisocial behaviour. Thus, this research raises critical questions about the development of severe antisocial behaviour (or psychopathy) through the childhood to adolescent years. Our evidence indicates that early adolecence may be the period when intrapsychological characteristics representing chronic risk become concrete. The current research will be the first to map the development common neuropsychiatric markers (affective empathy, punishment insensitivity) of severe antisocial processes through the late childhood-adolescent period. The findings will have clear implications for models of antisocial behaviour and clinical approaches to working with conduct problem children and adolescents.