Neurobiological assessment in screening and prediction

Neurobiological assessment in screening and prediction

Neurobiological assessment in screening and prediction

Symposium92Lucres Nauta-Jansen, AmsterdamUMC, The Netherlands; Helena Oldenhof, AmsterdamUMC, The Netherlands; Neeltje Blankenstein, AmsterdamUMC, The Netherlands

Room 4DThu 14:00 - 15:30

In the past decades, a wealth of knowledge has been gathered on neurobiological characteristics of antisocial youth. Among the most consistent findings is a general low arousal in antisocial youth, as can be measured on f.i. basal autonomic nervous system activity and reactivity to emotional cues. The main challenge for the upcoming years is to translate this knowledge to clinical practice.

In this symposium we will explore whether neurobiological measures can help us to gain insight in specific needs of subgroups of antisocial youth. We will discuss results of some recent neurobiological studies focusing on assessment of specific subgroups of antisocial youth and how the results may help us to better predict specific delinquent behavior an eventually tailor interventions to the specific needs of youth.

Presentation 1: Girls, just as fearless as boys? Comparing the automatic stress response between girls and boys with and without conduct disorder

Boys with Conduct Disorder (CD) demonstrate an attenuated neurobiological stress- response, which is suggested to index fearlessness. Fearlessness, in turn, may put children and adolescents at risk for engaging in antisocial behavior and to be more resistant to punishment. However, it is unclear whether this is also true for girls with CD, since there is evidence for sex-differences in the presentation and neurobiology of CD. Therefore, we investigated girls and boys with and without CD to identify sex-specific correlates of CD. This may aid the development of specific targets for interventions for girls and boys.

We investigated 108 girls and 72 boys with CD and compared them with 119 girls and 84 boys that were typically developing (TD). Heart rate (HR), Pre-ejection period (PEP), and Respiratory Sinus Arrhythmia (RSA) were assessed during a validated public speaking stress protocol (TSST). We distinguished between CD with/without Limited Prosocial Emotions (LPE), and CD with/without internalizing comorbidity (INT).

Results showed that CD youths reported similar levels of psychological stress, but exhibited diminished autonomic stress relative to TD youths, as indexed by HR, PEP and RSA. This was true for both boys and girls.

We conclude that impaired stress-regulation is a robust indicator of CD, irrespective of sex and CD-subgroup. These findings may suggest fearlessness as a specific mechanism underlying CD which may indicate specific treatment needs.

Presentation 2: Development of a biopsychosocial prediction model and practical tool for identifying subgroups of detained youth

Juvenile delinquents constitute a very heterogeneous group, with different needs for treatment and risk assessment. In clinical practice, mainly psychosocial characteristics are used to establish these needs, while neurobiological variables have not yet been integrated in this context. Therefore, we aimed to develop a model to identify clinically relevant subgroups associated with youth offending outcomes, based on psychosocial and neurobiological characteristics.

A group of 263 detained youth from juvenile justice institutions was studied. Latent class regression analysis was used to detect subgroups associated with offending outcome (recidivism at 12 month follow-up). As a proof of principle, it was tested whether individual cases could be assigned to the identified subgroups.

Three subgroups were identified: a ‘high risk – externalizing’ subgroup, a ‘medium risk – adverse environment’ subgroup, and a ‘low risk – psychopathic traits’ subgroup. Within these subgroups, both autonomic nervous system and neuroendocrinological measures added differentially to the prediction of types of reoffending (no, non-violent, violent). With the resulting model, it was possible to assign 92.1% of the participant to the correct subgroup.

This kind of model, which provides a practical decision tool, may in the future help to actually integrate neurobiological measures in clinical practice. After further development, the tool may be used in clinical practice to identify subgroups of detained youth with similar needs. This information can then be used to further tailor treatment to the specific needs and re-offending risk of individuals in that subgroup.

Presentation 3: Who is at risk? Using the biopsychosocial model to predict delinquency: A multi-sample latent-class regression study

Adolescents who show antisocial behavior are at high risk of developing problems throughout their lifetime, with major societal costs. The biopsychosocial model states that an interaction between biological (e.g. testosterone), psychological (e.g. empathy) and social environmental factors (e.g. trauma) contribute to the emergence and persistence of antisocial behavior in youth, such as non-violent and violent delinquency. Here we applied the biopsychosocial model to examine who is at risk for violent and non-violent delinquency. We harmonized five datasets of youth varying in antisocial behavior severity (total N=871, 82% male, M=17.67 years old, range 9-27 years), and applied latent class regression analyses to predict non, non-violent, and violent delinquency.

First we formed classes based on biological factors (heart rate indices, skin conductance, testosterone, cortisol (awakening)) and incorporated psychological predictors (empathy; psychopathic traits; internalizing, externalizing, attention problems; proactive, reactive aggression), thus taking into account that the influence of psychological variables may differ within the biological classes. Next, we predicted delinquency (non, non-violent, violent delinquency) from these psychologically-informed biological classes, moderated by social environmental factors (age, sex, SES, ethnicity, IQ, trauma, substance use).

This study revealed four classes of youth; the ‘biological susceptible - high psychopathic traits’ group, the ‘low problem group’, the ‘high problem – high psychopathic traits’, and the ‘biological susceptible – externalizing, reactive’ who differ on their biological and psychological profiles, which are differentially related to violent and non-violent delinquent outcomes depending on the social environment.

These results thus highlights the complicated interplay between biological, psychological, and social factors in assessing who is truly at risk. Together, we echo the need for a comprehensive, fine-mazed biopsychosocial approach in research and clinical and forensic practice.
Co-author: Eshter de Ruigh

Neurobiological & - psychological intervention studies
biopsychosocial, neurobiology, prediction
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