Conduct problems in youth and the RDoC approach: A developmental, evolutionary-based view

Highlights

• Conduct problems in youth are an important societal and mental health problem.

• A developmental psychopathology view inspired by RDoC is presented.

• Problems with a social learning system that protects from aggression are central in explaining conduct problems.

• Heterogeneity in pathways to conduct problems is described.

• Research and clinical implications of this view are discussed.

Abstract

Problems related to aggression in young people are traditionally subsumed under the header of conduct problems, which include conduct disorder and oppositional defiant disorder. Such problems in children and adolescents are an important societal and mental health problem. In this paper we present an evolutionarily informed developmental psychopathology view of conduct problems inspired by the NIMH Research Domain Criteria (RDoC) initiative. We assume that while there are many pathways to conduct problems, chronic or temporary impairments in the domain of social cognition or mentalizing are a common denominator. Specifically, we conceptualize conduct problems as reflecting temporary or chronic difficulties with mentalizing, that is, the capacity to understand the self and others in terms of intentional mental states, leading to a failure to inhibit interpersonal violence through a process of perspective-taking and empathy. These difficulties, in turn, stem from impairments in making use of a normally evolutionarily protected social learning system that functions to facilitate intergenerational knowledge transmission and protect social collaborative processes from impulsive and aggressive action. Temperamental, biological, and social risk factors in different combinations may all contribute to this outcome. This adaptation then interacts with impairments in other domains of functioning, such as in negative and positive valence systems and cognitive systems. This view highlights the importance of a complex interplay among biological, psychological, and environmental factors in understanding the origins of conduct problems. We outline the implications of these views for future research and intervention.

Introduction

Over the past decades our understanding of conduct problems in children and adolescents has deepened, and several comprehensive theoretical approaches in this area have been proposed (Blair, 2013, Frick et al., 2014a, Frick et al., 2014b, Kochanska and Kim, 2012, Matthys et al., 2013, Pedersen, 2004, Viding and McCrory, 2012). Some of these approaches have already been explicitly related to the Research Domain Criteria (RDoC) approach (Blair, White, Meffert, & Hwang, 2014). This paper leans heavily on this prior work and our own earlier formulations (Bateman and Fonagy, 2008, Caspi et al., 2014, Fonagy, 2003b, Fonagy, 2004, Hill et al., 2007, Hill-Smith et al., 2002), and also expands on them.

Consistent with the RDoC approach, our starting point is the notable heterogeneity of conduct problems in childhood and adolescence and their high comorbidity with other disorders (Blair, 2013, Caspi et al., 2014, Frick et al., 2014a, Lahey et al., 2008, Patalay et al., 2015, Pedersen, 2004). In this context, descriptive, disorder-centered approaches are unlikely to further our insights into the causes of conduct problems and their effective prevention and treatment (Cuthbert and Insel, 2013, Luyten and Blatt, 2011). The RDoC approach has the potential both to address diagnostic heterogeneity and to enable the construction of models with coherently linked elements that take into consideration a diagnostic group's phenomenological homogeneity. At the same time, the approach we take in this paper is also fundamentally rooted in developmental psychopathology. The marked heterogeneity in pathways to conduct problems has become increasingly clear by now, recognizing multiple developmental pathways that can lead to a particular category of pathology (Cicchetti & Rogosch, 1996). This paper will advance a theoretical model for understanding conduct problems that has sprung out of the confluence between two powerful heuristic frameworks—RDoC on the one hand, and an evolutionary informed developmental psychopathology approach on the other. Indeed, although definitely not incompatible with such an approach, traditional developmental psychopathology accounts often lack the consistent focus on different domains of functioning across different disorders that is central in RDoC. At the same time, an analysis in terms of RDoC domains risks neglecting the existence of different processes and factors impinging on such processes across development. Throughout this paper, we will highlight the need for a developmental perspective in research on aggression, as there seem to be critical periods in the development of aggression, and thus also time windows when prevention and intervention may be most effective.

Specifically, we argue that developmental pathways implicated in aggressive behavior typically involve temporary or enduring impairments in social cognition (Sharp, Fonagy, & Goodyer, 2008), in particular the capacity for social learning and the use of mental-state awareness (mentalizing) to appropriately interpret social actions and moderate/regulate behavior. In RDoC terms, we propose that difficulties with systems for social processes are key in major group(s) of individuals diagnosed with conduct problems and aggressive behavior more generally. But paths to and from problems of social impairment define distinct courses of the disorder with varying key points for effective intervention (Viding, McCrory, & Seara-Cardoso, 2014). We will review evidence for the moderating role of other RDoC domains in explaining these impairments. We favor the view that, from an evolutionary and developmental perspective, problems related to aggression reflect problems with the use of a normally evolutionarily protected social learning system that functions to facilitate intergenerational knowledge transmission and protect social collaborative processes from impulsive and aggressive actions. This difficulty interacts with impairments in other domains of functioning, such as in negative and positive valence systems and cognitive systems, although they may also generate aggressive behavior without implicating social processes in causation. We hope the model advanced below will generate clinical strategies as well as identifying gaps in our knowledge, leading to novel lines of research.