Improve knowledge around the causes of Personality Disorder (PD)

• DSPD co-funds a project which seeks to identify the extent to which the emergence of psychopathic traits in children result from genetic or environmental influences.

Early findings indicate that emerging psychopathic traits in children may have a significant genetic basis. However, given that some children with psychopathic traits do not exhibit anti-social behaviour, environmental factors also have a role to play.

• One of our studies is seeking to identify those children with attention deficit hyperactivity disorder (ADHD) who are most likely to develop anti-social personality disorder (ASPD), and any factors which mediate this link.

Early findings suggest that a gene variant and birth weight may be predictive of anti-social behaviour. Additionally, some individuals may be more sensitive to environmental adversity than others.

• A case file analysis is looking at the developmental pathways leading adolescents into sexually abusive behaviour with and without emerging personality disorder (PD).

Early findings indicate a number of risk factors such as problems at birth, family instability in early life and particular behaviours (e.g. cruelty to animals) may predict the emergence of sexually abusive behaviour and later PD.

Explore the relationship between PD and serious offending behaviour

• The DSPD programme has commissioned a survey of prisoners serving sentences of at least 2 years for sexual or violent offending. Data has been gathered to score each of these prisoners on the DSPD risk measures and other neuropsychological and clinical assessments.

Prisoners are then followed up post release and interviewed whilst under the supervision of the Probation Service. Further follow up in terms of reconviction will also be conducted.

Early findings suggest some associations between offender motivations (‘emotional, psychological or material need that impels, and is satisfied by a behaviour’ Turvey 1999) and index offence, between age and index offence, between types of substance abuse and index offence, and to a lesser extent between PD and index offence.

Evaluate specific assessment and treatment programmes

• Two separate studies are ongoing in order to evaluate treatment interventions for adolescents with conduct problems.

• A research study has focussed on the DSPD assessment process at HMP Whitemoor in terms of its reliability, cost-effectiveness, perceptions amongst staff and inmates.

Early findings highlight good reliability of assessments conducted. Additionally, the reasons given by inmates for participating in DSPD have been explored.

• DSPD is co-funding an evaluation of a community based treatment for individuals with PD.

Early findings highlight the lack of treatment for people with PD in the community. This study also offers useful insights into problems and solutions when delivering a PD intervention in the community.

Other projects include, amongst other things, an evaluation of a treatment intervention for patients with PD at Ashworth hospital.

This research programme will assist in the development of services for some of the most dangerous people in society.

For further information contact:

Dr Malcolm Ramsay
Telephone: 020 7035 6901
Email: malcolm.ramsay@homeoffice.gsi.gov.uk

Investigating the aetiology and developmental pathways related to the emergence of psychopathic tendencies in children

Dr Essi Viding, MRC SGDP Centre, Institute of Psychiatry, De Crespigny Park, London SE5 8AF

Identifying origins of Antisocial Personality Disorder (ASPD) is an NHS research priority(1). This project capitalised on an existing study of young twins to provide unique data in this priority area.

The completed project launched a research programme that follows the twins as they grow up. We can use the data from this study to investigate if children with psychopathic tendencies emerge as particularly high-risk individuals for on-going antisocial behaviour. Comparison of identical and non-identical twins and the inclusion of tasks that assess twins’ thinking patterns make it possible for us to study to what extent behaviour and thought biases are of genetic and / or environmental origin.

Bailey(1) described the need to identify high-risk individuals and to allocate individually tailored resources for intervention. As individuals with Conduct Disorder (CD; antisocial behaviour disorder in children) are likely to be 10 times more costly to society compared with individuals with no such disorder(2) it is important to develop ways of accurately identifying at risk individuals for individualised intervention.

We recently found that antisocial behaviour in children with psychopathic tendencies is mainly due to genetic influences. This finding has received much public attention and highlights the importance of support for this area of research. Strong genetic influence does not mean that nothing can be done for these children. Children are open to protective environmental influences early in life and these influences can modify the effect of genetic vulnerability. We need to understand more about the development of antisocial behaviour in this genetically vulnerable group to be able to provide targeted intervention.

The completed project focused on one possible risk factor for Antisocial Personality Disorder, psychopathic tendencies in middle childhood. Individuals with psychopathy incur great costs to society. Adult psychopathic criminals commit a disproportionate amount of crime and lack remorse for their behaviour(3). Four times as many psychopaths commit violent crimes while on release as those diagnosed with ASPD(4) and psychopaths appear particularly resistant to current forms of therapeutic interventions(5).

Several studies suggest that individuals with psychopathic tendencies form a more distinct group within the wider group of individuals meeting criteria for CD. Research on children with psychopathic tendencies and adult psychopaths suggests that these individuals have problems in feeling empathy for others’ distress and that they do not respond to punishment (e.g. being excluded from company) in the same way that other children do. Findings from this project also suggest that early onset antisocial behaviour is under strong genetic influence in children with psychopathic tendencies. This study demonstrates that the origins of antisocial behaviour differ between subgroups of children with early onset antisocial behaviour.

It is not currently known whether the difficulties children with psychopathic tendencies experience in their ability to feel empathy and in understanding emotions are influenced genetically. We also do not know if the relationship between behavioural difficulties and emotional difficulties is due to genetic influences. We hope that our results will begin to inform the development of tailored treatment programmes to children with early-onset conduct disorder.

The project thus aimed to provide a clearer understanding of developmental pathways leading to chronic antisocial behaviour using a large community sample, which also allows for the investigation of both genetic and environmental risk and protective factors. Inclusion of tasks that test empathy and ability to understand emotions in others were included. Finally, the use of a twin sample that will allow us to look at relative importance of genes and environment will lay the foundations for future molecular genetic research that can identify specific genes which will promote early screening and preventative interventions.

References:
1. Bailey S. (2002) Antisocial personality disorder: children and adolescents. FMH expert paper www.nfmph.org.uk/expertpaper.htm
2. Scott S., Knapp M., Henderson J., Maughan B. (2001) Financial cost of social exclusion: follow up study of antisocial children into adulthood. BMJ 323 (7306): 191
3. Hare R.D. (1991)
4. Hempell (1998)
5. Shine J., and Hobson J. (2000) Institutional behaviour and time in treatment among psychopaths admitted to a prison-based therapeutic community. Med Sci Law. 40(4):327-35.

Although the analyses on this dataset are still on-going, we have already learned a substantial amount. The novel findings of this study so far are:
a) Psychopathic tendencies are under considerable genetic influence. The genetic effects are particularly strong for boys.
b) Ability to make moral judgements is under environmental influence.
c) Difficulties in fear attribution show some genetic influence. The relationship between psychopathic tendencies and poor fear attribution was genetically mediated.
d) We replicated our earlier finding that early-onset antisocial behaviour in children with psychopathic tendencies is under strong genetic influence. We will now start a study that will look for genes associated with psychopathic tendencies.

Our participants were twins from a population-based sample. 574 twin pairs with high levels of psychopathic personality traits. 695 twin pairs without high levels of psychopathic personality traits.

Our participants are not receiving treatment within the study framework and only a small minority is likely to be in treatment otherwise.

The immediate impact of our study on service provision is low. However, there is potential for significant long-term impact. Taking note of the different origins of antisocial behaviour in different groups (more genetic influence in children with psychopathic tendencies) when treating early-onset antisocial behaviour is important. Treatment forms a significant potential for beneficial gene-environment interaction (where the treatment is an environmental agent that modifies the genetic risk) and developing programmes that address particular vulnerabilities and capitalise on potential strengths to promote alternative routes to positive socialisation should be a priority. Dr. Viding is currently liasing with Dr. Steven Scott, who has extensive experience in treatment development and provision, to explore such possibilities.

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