THE PSYCHIATRIC, BEHAVIORAL AND NEURAL CORRELATES …
Transcript of THE PSYCHIATRIC, BEHAVIORAL AND NEURAL CORRELATES …
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THE PSYCHIATRIC , BEHAVIORAL AND NEURAL CORRELATES OF
EARLY CHILDHOOD OVERCONTROL
Kirsten Gilbert, Ph.D., Chad Sylvester, M.D.,
Deanna Barch, Ph.D., & Joan Luby, M.D.
from Lynch, 2018
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from Lynch, 2018
BACKGROUND: OVERCONTROL IN YOUTH
Behavioral
Inhibition
Social anxiety
disorder
ERN / Inhibitory control
Personality Framework: Cluster of temperamental/personality characteristics
Resilient, Undercontrolled, overcontrolled (RUO) types
Five Factor Model: low extraversion, high neuroticism (low openness, elevated conscientiousness and agreeable)
Temperament: “Reactive control”
Rigid, inflexible form of behavioral inhibition
Behavioral Inhibition (BI): Neural or behavioral indicator
The error-related negativity (ERN)
Moderates risk between BI and social anxiety
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“OVERCONTROL”
• Transdiagnostic temperamental or
personality style associated with
too much self-control and
heightened performance
monitoring
• Performance monitoring:
monitoring of one’s performance
helps detect and learn from errors
and adapt to changing
environments
OCDsocial functioning
deficits
Overcontrol
Heightened
Performance
Monitoring
cognitive inflexibility/rigidity
perfectionism
checking
social anxiety
anorexia personality disorders:
OCPD, Avoidant
chronic depression
anxious apprehension
AIMS
1) Develop a measure to identify the overcontrolled phenotype in early
childhood (4-7 year olds) [Study 1]
1) In relation to cognitive, social and psychiatric functioning
2) In relation to neural error monitoring (using EEG)
2) Identify the overcontrolled phenotype in middle childhood (8-12 year olds)
[Study 2]
1) In relation to anxiety
2) In relation to neural error monitoring (using fMRI)
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STUDY 1: PARTICIPANTS
• 147 children ages 3-7 years
• Mean Age(SD) = 5.29(1.02)
• 33% female 82% Caucasian
• 95 PO-MDD (Preschool onset major depression)
• 52 healthy community children (below CBCL clinical cut-off of 70)
• Subset completed neural EEG Assessment (n=64)
Gilbert, Barch & Luby, 2019
OVERCONTROL IN YOUTH CHECKLIST (OCYC)
• Parent report (over the last year):
• “gets upset or has trouble when plans change at short notice”
• “pays a lot of attention to how s/he does things compared with others”
• “gets frustrated when s/he can’t seem to get it right the first time (e.g., when
solving a puzzle, when completing a math problem)”
• ”looks for reassurance that s/he has done well or done the right thing more than
siblings or other kids his/her age”
• Inflexibility/Frustration with Change Subscale α= .86
Gilbert, Barch & Luby, 2019
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OVERCONTROL IN YOUTH CHECKLIST (OCYC)
• Parent report (over the last year):
• “gets upset or has trouble when plans change at short notice”
• “pays a lot of attention to how s/he does things compared with others”
• “gets frustrated when s/he can’t seem to get it right the first time (e.g., when
solving a puzzle, when completing a math problem)”
• ”looks for reassurance that s/he has done well or done the right thing more than
siblings or other kids his/her age”
• Inflexibility/Frustration with Change Subscale α= .86
• Social Concern/Perfectionsim Subscale α= .80
Gilbert, Barch & Luby, 2019
OVERCONTROL IN YOUTH CHECKLIST (OCYC)
• Parent report (over the last year):
• “gets upset or has trouble when plans change at short notice”
• “pays a lot of attention to how s/he does things compared with others”
• “gets frustrated when s/he can’t seem to get it right the first time (e.g., when solving
a puzzle, when completing a math problem)”
• ”looks for reassurance that s/he has done well or done the right thing more than
siblings or other kids his/her age”
• Inflexibility/Frustration with Change Subscale α= .86
• Social Concern/Perfectionsim Subscale α= .80
• Total Overcontrol α = .88
• Age (r=.17, p=.04) BI (r=.44, p<.001) Depression status t(145)-10.04 (p<.001)
r = .59, p < .01
Gilbert, Barch & Luby, 2019
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COGNITIVE, SOCIAL AND PSYCHIATRIC OUTCOMES
Measure Assesses
Behavioral Inhibition Scale and Behavioral
Activation Scale
(BIS/BAS)
Behavioral Inhibition (BI)
Behavior Rating Inventory of Executive
Functioning (BRIEF)
Inhibition, Shifting, Emotional Control,
Working Memory,
Plan/Organize
MacArthur Health and Behavior
Questionnaire (HBQ)
Global peer relations, Peer
acceptance/rejection, Bullied by peers
Child Behavior Checklist (CBCL) Internalizing and Externalizing symptoms
Gilbert, Barch & Luby, 2019
*Regression predicting Overcontrol
OCYC
Executive
Functioning (BRIEF)
Total
B(SE)
Inflexibility/Frustration
with change
B(SE)
Social Concern/
Perfectionism
B(SE)
Inhibit .06(.03) .06(.02)** .002(.02)
Shift .13(.03)** .08(.02)** .05(.02)*
Emotional Control .03(.03) .03(.02) .01(.02)
Working Memory -.06(.03) -.03(.02) -.02(.02)
Plan/Organize .06(.04) .02(.02) .04(.03)
*p < .05; **p < .001
OVERCONTROL & COGNITIVE FUNCTIONING
Gilbert, Barch & Luby, 2019
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*Partial correlations controlling for age, BI, depression status
OCYC
Total Inflexibility/Frustration
with change
Social Concern/
Perfectionism
Social Functioning (HBQ)
Global Peer Relations -.19 -.05 -.29*
Peer Acceptance -.20 -.09 -.26*
Bullied .15 .001 .26*
Psychopathology (CBCL)
Internalizing symptoms .22* .24* .13
Externalizing symptoms .46** .49** .28*
*p < .05; **p < .001
OVERCONTROL AND PSYCHIATRIC & SOCIAL FUNCTIONING
Gilbert, Barch & Luby, 2019
NEURAL CORRELATES OF OVERCONTROL
• Error Related Negativity (ERN)
• Negative deflection when make a behavioral error
• Heightened performance monitoring
• Blunted ERN:
• 6 year olds= fear, maternal history anxiety, anxiety
symptoms
• Age 3 fear predicts blunted ERN at age 6
from Hijack (2012)
Gehring et al., 2012; Moser et al., 2013;
Santesso DL, Segalowitz SJ, Schmidt , 2005
Schrijvers et al., 2010; Torpey et al., 2013; Meyer et al., 2018
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ZOO TASK: GO/NO-GO TASK (ERN)
Go Trial Nogo Trial
75% trials 25% trials
OVERCONTROL & NEURAL CORRELATES
*Correlations OCYC
Total Inflexibility/Frustration
with change
Social Concern/
Perfectionism
Neural marker
ΔERN .31* .26* .30*
Overcontrol Associated with Blunted ΔERN
*Note, when partial correlations controlling for age, BI, depression completed, findings
no longer significantGilbert, Barch & Luby, 2019
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INTERIM CONCLUSIONS: STUDY 1
• Overcontrol is identifiable in 4-7 year olds
• It is associated with
• Executive functioning deficits: Cognitive shifting
• Poor social functioning (peer relations and being bullied)
• Temperament: elevated behavioral inhibition
• Psychopathology: internalizing and externalizing presentations
• Neural performance/error monitoring (blunted ΔERN)
STUDY 2: PARTICIPANTS
• 69 children ages 8-12 years
• Mean Age(SD) = 10.23(1.3)
• 52% female (n=36) 81% Caucasian (n=56)
• Via KSADS-PL:
• 35 with an anxiety disorder
• 34 with no anxiety disorder
• 38 subset with usable fMRI neuroimaging assessment
Gilbert, Perino, Myers & Sylvester, 2020
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PSYCHIATRIC & FUNCTIONING OUTCOMES
Measure Assesses
Pediatric Anxiety Rating Scale (PARS)
Summary scale
Interview-administered (to parent and
child) anxiety symptoms
Screen for Child Anxiety Related Emotional
Disorders (SCARED)
Parent-reported anxiety symptoms
Child Depression Inventory (CDI) Parent-reported depressive symptoms
Conners 3-Parent Short Parent-reported ADHD symptoms
Child Global Assessment Scale (cgas) Interviewer-rated Overall functioning
Gilbert, Perino, Myers & Sylvester, 2020
Anxiety
Disorder
No Anxiety
Disorder
Overcontrol (OCYC) (Mean(SD))
Total 9.12(4.6)** 4.18(2.5)
Inflexibility/Frustration with change 4.51(2.9)** 4.51(2.9)
Social Concern/Perfectionism 2.34(2.4)** 2.35(2.4)
Comorbid Psychiatric Diagnosis (%)
Depression diagnosis 7(20%) 3(8%)
ADHD diagnosis 2(6%) 1(3%)
**p < .01
OVERCONTROL AND PSYCHIATRIC & FUNCTIONING OUTCOMES
Gilbert, Perino, Myers & Sylvester, 2020
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*Partial correlations controlling for age
OCYC
Total Inflexibility/Frustration
with change
Social Concern/
Perfectionism
Anxiety
PARS-Severity .63** .56** .58**
SCARED-P .75** .69** .67**
Depression
CDI-P .63** .58** .56**
ADHD
Conners Inattention .38* .26* .44*
Conners Hyperactivity &
Impulsivity
.20 .13* .25*
Functioning
Child GAS -.57** -.51** -.53**
*p < .05; **p < .001
OVERCONTROL AND PSYCHIATRIC & SOCIAL FUNCTIONING
Gilbert, Perino, Myers & Sylvester, 2020
NEUROIMAGING ERROR TASK:MODIFIED POSNER CUEING PARADIGM
Number of errors not associated with overcontrol and didn’t differ by cue type
Gilbert, Perino, Myers & Sylvester, 2020
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BRAIN ACTIVITY TO ERROR
ROIs error>correct: Right and Left dACC Right medial PFC
Right and Left insula Right dorsal superior pre-motor cortex
ASSOCIATIONS WITH OVERCONTROL
*controlling for age
Gilbert, Perino, Myers & Sylvester, 2020
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CONCLUSIONS
• Overcontrol is identified early in development using novel parent-report
• Ages 5 – 12
• Is associated with transdiagnostic clinical presentations and maladaptive
outcomes
• Internalizing and externalizing psychopathology
• Strong associations with anxiety
• Worse cognitive, peer, and global functioning
• Blunted neural responding to errors
• Overcontrol may be a transdiagnostic mechanistic process
• Could be targeted in intervention (rather than treating specific
symptoms) (i.e., Radically Open Dialectical Behavior Therapy, RO DBT)
THANK YOU!
Colleagues & Collaborators:
John Luby, M.D.
Chad Sylvester, M.D.
Deanna Barch, Ph.D.
Nathan Fox, Ph.D.
Thomas Lynch, Ph.D.
Diana Whalen, Ph.D
EEDP Staff: Danielle Kelly, Ella Sudit, Becky Tillman, Gemma Baugh, Sarah
Engle, Brittany Haus, Alli Hollendar, Alex Puricelli, Megan Dandarund,
Shannon O’Hara and all the wonderful EEDP students
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