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.

[email protected]

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


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• “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)”




• Social Concern/Perfectionsim Subscale α= .80






• “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)”




• 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


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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


*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


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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


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


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


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


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*Partial correlations controlling for age

OCYC


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


NEUROIMAGING ERROR TASK:MODIFIED POSNER CUEING PARADIGM

Number of errors not associated with overcontrol and didn’t differ by cue type


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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


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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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THE PSYCHIATRIC, BEHAVIORAL AND NEURAL CORRELATES …