nature-nurture interplay in aggression and antisocial behaviour
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Nature-Nurture Interplay in Aggression and Antisocial Behaviour. Emily Simonoff Institute of Psychiatry London. Size of the Problem. Conduct disorders are the most common group of child psychiatric disorders - PowerPoint PPT PresentationTRANSCRIPT
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Nature-Nurture Interplay in Aggression and Antisocial
Behaviour
Emily SimonoffInstitute of Psychiatry
London
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Size of the Problem
• Conduct disorders are the most common group of child psychiatric disorders
• In the UK, over one quarter have been to CAMHS and three-quarters have sought some professional help
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Comorbidity
• About one-third of cases have another mental disorder
• About two-thirds have either a physical of developmental disorder
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Costs of Antisocial Behaviour
No problems
Conduct problems
Conduct disorder
Education £1508 £7524 £12478
Foster/resi-dential care
£1320 £3412 £7647
Health £247 £1237 £2178
Crime £2541 £8604 £44821
Total £7423 £24324 £70179
From Scott, 2001From Scott, 2001
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Conduct Disorder is Associated with Many Psychiatric Outcomes
Presence of Conduct Disorder by Age 15
11.5
22.5
33.5
4
anxiety
depression
maniaeating
schizophrenia
substance
APSD
odds
ratio
From Kim-Cohen et al, Arch. Gen Psychiatry., 2003
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Treatment Effects
• Community parenting programs of preschoolers– non-significant effect favouring intervention
• Research/academic programs for preschool to primary school– 0.5-1.0 SD treatment effect
• Multisystemic therapy– 0.5 SD treatment effect
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Heritabilities for Conduct Disorder
0
0.2
0.4
0.6
0.8
Eaves et alEaves et alSlutske et alGjone & Stevenson
Gjone & Stevenson
Thapar & McGuffin
Lyons et alEdelbrock et alRowe
Zahn-Waxler
Gelhorn
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What do we know about precursors of antisocial behaviour?
Cognitive
Family
School
Neighbourhood
Behavioural &Personality--Individual
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Cognitive Risk Factors for Antisocial Behaviour
• Low IQ• Low verbal skills• Deficits in executive functioning, including
attentional problems• Poor academic attainments
– ? Cause or effect
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Parental Risk Factors for Antisocial Behaviour
• Marital discord• Paternal criminality• Maternal depression• Poor parental supervision• Harsh and inconsistent discipline
Are family factors environmental or genetic?Are they causal or responsive?
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Maternal Depression after Birth Relates to Conduct Problems
-0.3
-0.2
-0.1
0
0.1
0.2
0.3
0.4
Con
duct
z s
core
s
parentteacher
No depression Before birth After birth
Before & after birth
From Kim-Cohen et al, Arch Gen Psychiat 2005
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Amount of Maternal Depression and Conduct Problems
-0.3
-0.2
-0.1
0
0.1
0.2
0.3
0.4
0.5
Con
duct
z s
core
parent teacher
0 1 2 3
Number of depressive episodes
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Contribution of Maternal Disorder to Conduct Problems
-0.2
-0.15
-0.1
-0.05
0
0.05
0.1
0.15
0.2
z co
nduc
t sco
res
not depresseddepressed
Without ASPD With ASPD
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Reciprocal influences of parental discipline and antisocial behaviour:
Evocative gene-environment correlation
Adoptive parents’ Marital warmth
Adoptive parents’disciplinary practices
Biological parents’Psychiatric disorder
Adoptees’Antisocial behaviour
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Genetic Effects of Parental Discipline Style
0
0.2
0.4
0.6
0.8
1
punitive discipline constructive discipline
additive genetic common environmental unique environmental
From Lau et al, 2006, JCPP
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Monoamine Oxidate A
• X linked• Genetic mutation lading to reduced
MAO A activity associated with mild mental retardation and impulsive behaviour
• No evidence for direct role of MAO A in antisocial behaviour
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Effect of Monoamine Oxidase A on Brain
Low MAO A activity associated with:• Reduced volume of amygdala, cingulate
gyrus insula and hypothalamus• Increased amygdala activation to
emotional arousal and emotional memory (latter in males only)
• Decreased anterior cingulate activation to inhibition in males only
From Meter-Linden berg et al (2006) PNAS
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Interaction between monoamine oxidase A gene and maltreatment
from Caspi et al (2002)
% showing conduct disorder
0
20
40
60
80
100
high MAOA low MAOA
no maltreatment some maltreatment severe maltreatment
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Social Risk Factors for Antisocial Behaviour
• Family poverty• Minority ethnic status
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Familial Transmission of Antisocial Behaviour:
Passive Gene-Environment Correlation
genes genes
genesgenes
CDfather
CDmother
familydysfunction
CDtwin1
CDtwin2
E E
.5
.21
.04
.5(fixed)
.5
.19
C
.45
.72
from Meyer at al (2000)
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Effect of Neighbourhood on Heritability of Antisocial Behaviour
0.00
0.20
0.40
0.60
0.80
1.00
advantaged disadvantaged
additive genetic shared environemntal unique environmental
From Tuvblad et al, 2006 JCPP
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Neighbourhood Influences on Antisocial Behaviour
• Urban environment• High crime neighbourhood• Neighbourhood with high drug availability• Neighbourhood social cohesion• Exposure to violence• Delinquent peer group
Access to antisocial activities may increase antisocial behaviour
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School Effects on Conduct Problems
• School variation in delinquency, disruptiveness and absenteeism, having accounted for intake characteristics
• ‘better’ behaviour associated with school characteristics of:
• Clear leadership• Good classroom management• Academia emphasis• Consistent sanctions for misbehaviour
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Heritability of ADHD
Twin Studies of Parental Reports
0.0
0.2
0.4
0.6
0.8
1.0
Eaves et alThaparetal
GjoneGjone
GoodmanLevy et al
Price et al
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Shared genetic effects between ADHD and conduct disorder
ADHD Conduct disorder
Phenotypic correlation 0.3
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Shared genetic effects between ADHD and conduct disorder
Genes
ADHDConduct Disorder
Environment Environment
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Symptoms of ADHD predisposing to conduct disorder
Genes
ADHD
Environment
Genes
Conduct Disorder
Environment
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Association of DRD4 with ADHD
% allelic variation
<7 repeats 7-8 repeats
with ADHD 71 29without ADHD 88 12
Susceptibility genes are neither necessary nor sufficient to cause disease
from LaHoste et al (1996)
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Asherson (1998)
Castellanos (1998)
Comings (1999)
Holmes (1999)
Kennedy (1999)
La Hoste (1996)
Rowe (1998)
Swanson (1998)
Thapar (1999)
0 1 2 3 4 5 6 7 8Odds Ratio
N cases = 1266; N controls = 3068, p=0.00000008. Combined OR = 1.9 (1.5 – 2.2). Genome-wide significance level (1 per genome scan for association)
Case-control Studies of ADHD & DRD4
Faraone et al. 2000
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Molecular Genetics of ADHDGenetic Associations
replicated not replicated
DRD4 yes yesDAT1 yes yesDßHydroxylase yes yesDopa decarboxylase no noserotonin transporter yes noserotonin 2A receptor no noCOMT no yesMAOA yes yes
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Implications for Early DetectionShould genetic tests be used to guide
us in determining who is at risk
• How sensitive and specific are genetic tests in determining who will have disorder?
• Will early detection alter the prognosis or treatment for disorder?
• Are genetic studies the most efficient in identifying at risk populations?
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Genetic Influences on Antisocial Behaviour Increase with Age
Childhood conduct disorder Adult antisocial personality
gene common environment unique environment
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Long-term effect of hyperactivity on antisocial behaviour
hyperactivity conductdisorder
antisocialpersonalityage 21-30
antisocialpersonalityage 31+
7.7 5.0 29.6
2.2
delinquentpeer group
2.7
20.3
Simonoff et al (2004)
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Genetic Influences on Psychopathic Behaviour
• Unreliable• Untruthful• Lack guilt• Misbehave for no purpose• Do not learn from
punishment• Poor judgment• Don’t plan
• Insincere• Self-centered• No close relationships• No deep emotions• Lack personal insight• Unresponsive to kindness
or praise
Minnesota Temperament Inventory
From Taylor et al (2003)
Antisocial scale Detachment scale
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Genetic Influences on Psychopathic Behaviour
Minnesota Temperament Inventory
0
0.2
0.4
0.6
0.8
1
1.2
Antisocial scale Detachment Scale
Varia
nce
com
pone
nt
aditive genetics unique environment
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Callous/unemotional and antisocial behaviour in 7 year olds
• Does not show feelings or emotions
• helpful if someone is hurt, upset or feeling ill
• feels bad or guilt when done something wrong
• considerate of others’ feelings
• kind to younger children• concerned about how well
s/he is doing in school
• Often has temper tantrums or hot tempers
• generally obedient, usually does what adults request
• often lies or cheats• steals from home school
or elsewhere
Callous/unemotional Antisocial
Viding et al 2005
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Childhood callous/unemotional traits and antisocial behaviour
0
0.2
0.4
0.6
0.8
1
caullous unemotionaltraits
antisocialbehaaviour/high C/U
antisocial behaviournl C?U
varia
nce
com
pone
nt
genes common environment unique envionment
Viding et al, 2005
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Callous Unemotional Children Make More Errors Recognizing Sad/Fearful Faces
0
0.4
0.8
1.2
1.6
Sad Fear Happy Surprise Disgust Anger
erro
rs
CU Comparison
From Blair et al, 2000
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Cognitive Dysfunction in Psychopathy
• Failure to make stimulus-reinforcement associations particularly in relation to fearful or distressed stimuli
• Disruption in ability to alter stimulus-response associations
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Similar Communication Profiles in Children with Conduct Disorder and ASD
Children's Communication Checklist % Clinical Range
020406080
100
Use of Context Rapport SocialRelationships
Interests
Conduct ASD Autism Typically developing
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Deficits in Emotional Recognition in Hard to Mange Preschoolers
main effects of group, story type & emotion type
2
2.5
3
3.5
4
H2M control H2M control
unambiguous stories ambiguous sotries
mea
n sc
ore happy
sadangryscared
From Hughes et al JCPP, 1998
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Insensitivity of CU Children to Parenting Programs
oppositional defiant symptoms
0
1
2
3
4
5
pre-treatment post-treatment follow-up
scor
e low CUHigh CU
From Dadds & Hawes, in press
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Origins of Phenotypic Continuity
Behaviour Time 1
Behaviour Time 2
Behaviour Time 3
Genes time 1 Genes time 2 Genes time 3
Environment time 1``
Environment time 2
Environment time 3
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Implications for Research Directions
• Studies of antisocial behaviour need to begin early in life
• Risk factor research must start with adequate description of the child on a variety of dimensions
• Integration of measurement of risk factors from many perspectives is necessary