Empathy Impairments in Boys with Oppositional Defiant Disorder and Conduct Disorder: Examining Subtype Differences and The Role of Emotion Regulation

Abstract

Empathy, generally defined as the ability to understand and share another’s emotional state (Eisenberg & Strayer, 1987), is an important social skill. It is thought to foster prosocial behaviour (Hoffman, 2008) and inhibit unwanted behaviour, like aggression (Austin, Bondü, & Elsner, 2017). Empathy problems are often associated with oppositional defiant disorder (ODD) and conduct disorder (CD) (De Wied, Gispen-De Wied, & Van Boxtel, 2010). Children and adolescents with ODD/CD form a heterogeneous group, however, and researchers suggest that there are individual differences in the mechanisms underlying their empathy deficits (e.g., Blair, 2013; De Wied et al., 2010). The literature often distinguishes between those with and without callous unemotional (CU) traits. CU traits are an extension of the interpersonal-affective dimension of adult psychopathy and are identified by a lack of empathy, a lack of guilt and shallow affect (Frick & Hare, 2001). Over the years, empathy in those with high levels of CU traits has received much research attention. Far less attention has been dedicated to empathic functioning of those without CU traits. We have therefore limited knowledge about empathy problems in children and adolescents with ODD/CD.A more thorough investigation of these problems in ODD/CD subtypes is crucial for the development of more targeted and effective treatment strategies to improve empathic functioning in children and adolescents with ODD/CD. In light of this, the current dissertation aimed to elucidate the nature of empathy impairments in ODD/CD children and adolescents and to explore possible mechanisms involved. We have used a taxonomy suggesting that some individuals with ODD/CD may show a lack of empathy because of under responsiveness to other’s distress cues (CU subtype), whilst others may show a lack of empathy because of over responsiveness to other’s distress cues, hostility and/or poor emotion regulation abilities (non-CU subtype; De Wied et al., 2010). The first two studies of the current dissertation addressed empathy dysfunction related to the CU subtype, whereas the final two studies addressed empathy dysfunction related to the non-CU subtype. Findings from the current dissertation revealed that (1) children and adolescents with ODD/CD show more consistent impairments in affective empathy than in cognitive empathy, (2) that there are differences in empathy impairments among ODD/CD subtypes; that is, (3) those with and without CU traits exhibit distinct autonomic patterns to other’s distress cues, (4) those with higher CU traits report lower levels of empathic sadness, whilst those with higher ASD symptoms report lower levels of cognitive empathy, and finally (5) aspects of emotion regulation may be involved in empathy impairments among ODD/CD individuals. Future research should focus on the development of diagnostic instruments for affective empathy and further elucidate the role of emotion regulation in empathy-related responding and how this relates to social functioning in ODD/CD children and adolescents.