Antisocial Behaviour in Adolescents

175 Pages·2016·3.3 MB·English

by  Kelly Hubble

Antisocial Behaviour in Adolescents:
Exploring and Improving Emotion
Processing Deficits
Kelly Hubble

Thesis submitted for the Degree of Doctor of Philosophy
Cardiff University

August 2015
Declaration

This work has not been submitted in substance for any other degree or award at this or
any other university or place of learning, nor is being submitted concurrently in
candidature for any degree or other award.

Signed ……………………………………candidate) Date ………………………...

STATEMENT 1

This thesis is being submitted in partial fulfilment of the requirements for the degree of
PhD.

Signed ………………………………………(candidate) Date ...………………………

STATEMENT 2

This thesis is the result of my own independent work/investigation, except where
otherwise stated. Other sources are acknowledged by explicit references. The views
expressed are my own.

Signed ………………………………………(candidate) Date …...……………………

STATEMENT 3

I hereby give consent for my thesis, if accepted, to be available online in the
University’s Open Access repository and for inter-library loan, and for the title and
summary to be made available to outside organisations.

Signed ………………………………………… (candidate) Date ………………………

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Summary of Thesis

Antisocial behaviour in childhood and adolescence is associated with a range of
negative outcomes in later life, which are costly to both society and to the antisocial
individual themselves. Because the effectiveness of current interventions appears to be
limited, it has been argued that treatment efforts should focus more on designing
interventions that target neuropsychological correlates of antisocial behaviour. Two
important correlates are impaired facial emotion recognition and empathy; these deficits
have been proposed to cause antisocial behaviour because they involve an inability to
understand and appropriately respond to the distress of others.

This thesis aimed first to extend our understanding of emotion processing deficits
associated with antisocial behaviour by examining empathy in a large sample of
adolescent males with ADHD, who are at risk of developing antisocial behaviour.
Secondly, it was examined whether emotion function could be enhanced using an
emotion training programme and oxytocin.

Compared to participants with ADHD alone, participants with ADHD and Conduct
Disorder displayed problems in affective empathy for sadness, fear and happiness. We
also found that a facial emotion training programme improved facial emotion
recognition in young offenders; this group also showed a reduction in crime severity in
a six months follow-up period. Finally, we demonstrate that intranasal oxytocin reduces
emotional face-processing time, selectively enhances affective empathy for fear, and
increases attention to the eye-region in healthy males. Given these are key areas which
appear to be deficient in those who show severe and/or persistent antisocial behaviour,
the implications of these findings for developing future interventions for at-risk youths
are discussed.

Taken together, this thesis’ findings have valuable implications for practitioners
working with antisocial youths and suggest that interventions targeting specific
emotional deficits should be given further consideration.

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Acknowledgements

First and foremost I would like to acknowledge and thank my supervisor Prof.
Stephanie van Goozen for her invaluable guidance, feedback and support throughout the
PhD. I am also indebted to Prof. Antony Manstead, Prof. Anita Thapar and Dr Simon
Moore for their additional assistance and suggestions, and to Katie, Clare, Dan and
Erika for their help and general support through the struggles of data collection!

Special recognition must go to all the young people and their families who participated
in my studies, to the undergraduates willing to be drugged and to Aled, Andrew and
Anil for making sure they were OK. To Val for her tiresome efforts in recruiting
participants, and to the Cardiff Youth Offending Service - in particular Scott, Tor, Tony
and Mike, all without whom this research would not have been possible. I would also
like to extend my thanks to the School of Psychology at Cardiff University and the
Economic and Social Research Council, who provided the funding for this project.

Special thanks must also go to my friends and family - in particular to my parents for
always being there and for their continuous encouragement and to Lynn for
painstakingly proof reading parts of this thesis. Finally I would like to thank my
husband Sam for putting up with my rants throughout the PhD, for helping me make
sense and importantly for keeping me on track during the writing-up process and
reminding me of the fun that waits at the end! Vamos!
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Table of Contents
Declaration ............................................................................................................................... i
Summary of Thesis ................................................................................................................. ii
Acknowledgements ............................................................................................................... iii
List of Figures ....................................................................................................................... vii
List of Tables ........................................................................................................................ vii
List of Abbreviations ........................................................................................................... viii
1 Chapter 1 - Introduction ................................................................................................. 1
1.1 Studying Antisocial Behaviour in Adolescents ....................................................... 2
1.1.1 Why Study Antisocial Behaviour in Adolescents? .......................................... 2
1.1.2 Operationalising and Assessing Antisocial Behaviour .................................... 3
1.1.3 Reducing Heterogeneity: The Role of Aggressive Behaviour, Psychopathy
and Callous-unemotional Traits ..................................................................................... 4
1.2 The Importance of Emotion Processing in Understanding Antisocial Behaviour in
Adolescents......................................................................................................................... 8
1.2.1 What is the Link between Emotion Processing and Antisocial Behaviour? .... 8
1.2.2 What Emotional Deficits are Evident in Antisocial Populations? ................... 9
1.3 Improving Emotion Processing ............................................................................. 12
1.3.1 Why are Interventions Needed? ..................................................................... 12
1.3.2 Emotion Training as an Intervention for Antisocial Behaviour .................... 12
1.3.3 Oxytocin as an Intervention for Antisocial Behaviour .................................. 13
1.4 Goals and Hypotheses of the Thesis ...................................................................... 22
1.4.1 Empathy ......................................................................................................... 22
1.4.2 Facial Emotion Training ................................................................................ 22
1.4.3 Intranasal Oxytocin ........................................................................................ 23
1.4.4 Hypotheses and Research Questions ............................................................. 24
2 Chapter 2: Empathy impairments in adolescent males with ADHD and Conduct
Disorder ................................................................................................................................ 26
2.1 Introduction ........................................................................................................... 27
2.2 Method................................................................................................................... 31
2.2.1 Participants .................................................................................................... 31
2.2.2 Ethical Statement ........................................................................................... 32
2.2.3 Measures and Materials ................................................................................. 32
2.2.4 Data Analyses ................................................................................................ 37
2.3 Results ................................................................................................................... 37
2.3.1 Demographic Characteristics ......................................................................... 37
2.3.2 Cognitive Empathy ........................................................................................ 38
2.3.3 Affective Empathy ......................................................................................... 39
2.3.4 Correlates of Affective Empathy ................................................................... 40
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2.3.5 Cardiff Empathy Scoring System Validity .................................................... 41
2.4 Discussion ............................................................................................................. 42
2.4.1 Limitations ..................................................................................................... 45
2.4.2 Conclusions and Clinical Implication ............................................................ 47
3 Chapter 3: Improving negative emotion recognition in young offenders reduces
subsequent crime .................................................................................................................. 48
3.1 Introduction ........................................................................................................... 49
3.2 Method................................................................................................................... 53
3.2.1 Participants .................................................................................................... 53
3.2.2 Ethical Statement ........................................................................................... 54
3.2.3 Measures and Materials ................................................................................. 54
3.2.4 Data Analyses ................................................................................................ 58
3.3 Results ................................................................................................................... 58
3.3.1 Demographic Characteristics and Pre-training Crime Data........................... 59
3.3.2 Emotion Recognition: Training and Control Group Comparisons ................ 60
3.3.3 Reoffending Data 6 Months After Testing .................................................... 62
3.4 Discussion ............................................................................................................. 63
3.4.1 Limitations ..................................................................................................... 65
3.4.2 Conclusions and Clinical Implications .......................................................... 67
4 Chapter 4: Oxytocin improves facial emotion recognition efficiency but leaves
accuracy and eye-gaze unaffected ........................................................................................ 68
4.1 Introduction ........................................................................................................... 69
4.2 Method................................................................................................................... 71
4.2.1 Participants .................................................................................................... 71
4.2.2 Ethical Statement ........................................................................................... 71
4.2.3 Measures and Materials ................................................................................. 72
4.2.4 Procedure ....................................................................................................... 73
4.2.5 Data Analyses ............................................................................................... 74
4.3 Results ................................................................................................................... 75
4.3.1 Recognition Accuracy ................................................................................... 75
4.3.2 Face Processing Time .................................................................................... 76
4.3.3 Eye-gaze ........................................................................................................ 77
4.3.4 Association between Gaze to the Eye-Region, Emotion Recognition and Face
Processing Time ........................................................................................................... 78
4.4 Discussion ............................................................................................................. 78
4.4.1 Limitations ..................................................................................................... 82
4.4.2 Conclusion and Clinical Implications ............................................................ 83
5 Chapter 5: In the Face of Fear: Oxytocin increases attention to the eyes and selectively
enhances affective empathy for fear ..................................................................................... 85
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5.1 Introduction ........................................................................................................... 86
5.2 Method................................................................................................................... 89
5.2.1 Participants .................................................................................................... 89
5.2.2 Ethical Statement ........................................................................................... 89
5.2.3 Measures and Materials ................................................................................. 89
5.2.4 Procedure ....................................................................................................... 90
5.2.5 Data Analyses ................................................................................................ 91
5.3 Results ................................................................................................................... 91
5.3.1 Cognitive Empathy ........................................................................................ 91
5.3.2 Affective Empathy ......................................................................................... 92
5.3.3 Eye-gaze Patterns........................................................................................... 93
5.3.4 Comparing Empathy and AOI ....................................................................... 95
5.4 Discussion ............................................................................................................. 96
5.4.1 Limitations ..................................................................................................... 98
5.4.2 Conclusions and Clinical Implications ........................................................ 100
6 Chapter 6 – Discussion ............................................................................................... 101
6.1 Overall findings ................................................................................................... 101
6.1.1 Understanding Empathy in Adolescents with ADHD and CD .................... 101
6.1.2 Improving Emotion Processing ................................................................... 102
6.1.3 What is the Evidence that Antisocial Behaviour is linked with General or
Specific Emotion Problems? ...................................................................................... 104
6.1.4 What is the Evidence that the Severity of Antisocial Behaviour and CU traits
explain Deficits in Emotion Processing?.................................................................... 106
6.1.5 Why is Antisocial Behaviour Associated with Deficient Recognition of
Emotion but Intact Cognitive Empathy? .................................................................... 108
6.1.6 What is the Evidence that Intranasal OXT Improves Emotion Processing in
Healthy Males? ........................................................................................................... 111
6.1.7 What is the Evidence that Intranasal OXT is involved in Enhancing Social
Salience?..................................................................................................................... 113
6.1.8 What is the Evidence that Emotion Processing can be improved in Young
Offenders? .................................................................................................................. 115
6.1.9 What is the Evidence that Intranasal OXT may be a Potential Intervention for
Antisocial Behaviour? ................................................................................................ 115
6.2 Strengths, Limitations and Future Directions ...................................................... 120
6.3 Implication and Conclusions ............................................................................... 127
References .......................................................................................................................... 129
Appendix 1 - Offence severity scores ................................................................................. 160

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List of Figures
Figure 2.1 Cognitive empathy scores as a function of ADHD type………………. 39
Figure 2.2 Affective empathy score as a function of ADHD type…………..….… 40
Figure 3.1 Example stimuli selected from Bowen et al., (2014)………………...... 56
Figure 3.2 Mean fear, sadness, anger, happiness and disgust recognition scores
for young offenders in the Training (TR) or Control (CON) group at
pretest (Pre) and retest (Post)……………………………………..…... 62
Figure 3.3 Effect of emotion training on crime: Offence severity 6 months before
(pre) and 6 months after (post) for young offenders in the Training
(TR) or Control (CON) group…………………………….................... 63
Figure 4.1 Example AOI showing the eyes, mouth and rest of the face AOIs.….... 74
Figure 4.2 Mean recognition accuracy scores as a function of Emotion and Drug.. 76
Figure 4.3 Mean face processing time as a function of Emotion and Drug………. 77
Figure 4.4 Mean percentage dwell-time as a function of Emotion, AOI and Drug.. 78
Figure 5.1 Cognitive empathy as a function of Emotional clip and Drug………… 92
Figure 5.2 Affective empathy as a function of Emotional clip and Drug…………. 93
Figure 5.3 Percentage dwell time as a function of AOI and Drug………………… 94
Figure 5.4 Heat maps of the OXT condition and the PL condition……………….. 94
Figure 5.5 Percentage dwell time as a function of AOI and Emotion…………….. 95

List of Tables
Table 2.1 The Cardiff Empathy Scoring System for cognitive and affective
empathy……………………………………………………………….. 36
Table 2.2 Demographic characteristics of adolescents………………………….. 38
Table 2.3 Inter-correlations between key variables……………………………... 40
Table 2.4 Summary of simple regression analyses for variables predicting
affective empathy for sadness, happiness and fear…………………… 41
Table 2.5 Correlational validity between measures of empathy………………… 42
Table 3.1 Demographic characteristics and offending data of young offenders… 59
Table 5.1 Relationship between eye-gaze and empathy………………………… 96

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List of Abbreviations

The following abbreviations are used in this thesis.

ADHD Attention Deficit Hyperactivity Disorder
AE Affective Empathy
AOI Area of Interest
APA American Psychiatric Association
ASD Autism Spectrum Disorders
ASPD Antisocial Personality Disorder
CD Conduct Disorder
CESS Cardiff Empathy Scoring System
CON Control group
CU Callous and unemotional
DAAM Differential Amygdala Activation Model
DAWBA Development and Well Being Assessment
DBD Disruptive Behaviour Disorders
DSM Diagnostic and Statistical Manual of Mental Disorders
EC Empathy Continuum
FAR Facial Affect Recognition
FER Facial Emotion Recognition
GBH Grievous bodily harm
HR Heart rate
ICD International Classification of Diseases
IES Integrated Emotion Systems
IQ Intelligence Quotient
IU International Units
MC Matched Controls
NICE The National Institute for Health and Care Excellence
ODD Oppositional Defiant Disorder
OXT Oxytocin
OXTR Oxytocin receptor gene
PL Placebo
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SES Socioeconomic Status
SCL Skin conductance level
TR Training group
TWOC Taking [vehicle] without owner’s consent
UK United Kingdom
WASI Wechsler Abbreviated Scale of Intelligence
YO Young offender
YOS Youth Offending Services
YPI Youth psychopathic traits inventory
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