Insensibilidad emocionalestructura, perfil evolutivo y relación con otras dimensiones

Resumo

The term Callous Unemotional Traits (CU) or Hardness and Emotional Insensitivity has been termed Limited Prosocial Emotions (LPE) in DSM-5 (APA, 2013) and ICD-11 (WHO, 2018). CU includes characteristics of lack of guilt and remorse, insensitivity and absence of empathy, lack of concern for performance in relevant activities, and shallow or deficient affect. These traits were included in the emotional dimension of the psychopathy described in adults by Cleckley (1941/1976). In order to evaluate CU, scales such as the Inventory of Callous Unemotional Traits (Frick, 2004) have been used, as well as brief measurement scales. These scales have obtained diverse reliability values and are made up of items with different levels of representativeness of the construct. CU characteristics have been proven to be relatively stable over different age ranges, although there are varied data with regard to stability. In addition to being studied in the context of Conduct Disorder (CD), in recent years some studies have associated CU with Oppositional Defiant Disorder (ODD), although the results concerning the direction of the predictive relationship between both constructs are not unanimous. - Research content: The main objectives of this thesis, formed by a compendium of three papers, are: 1) To study the psychometric properties of a brief scale ("Prosocial Emotions Scale" or "PE scale") developed from the four items of the LPE specifier, based on information from four raters (fathers, mothers, primary and ancillary teachers) of two settings (home, school). The data from the PE scale were compared with other externalizing measures (Attention Deficit and Hyperactivity Disorder in its Inattention (ADHD-IN) and Hyperactivity (ADHD-HI) dimensions, and the ODD), and with measures of academic (AI) and social impairment (SI). The results indicated that the PE scale turned out to be reliable and showed structural and measurement invariance. The PE scale also obtained good convergent and discriminant validity in the same context but not between contexts, and predicted academic and social impairment for at least one rater from each context. 2) To study the stability over time and consistency across settings ("trait" or "state" behaviour) of the PE scale between 1st and 2nd Grades, in comparison with ADHD-IN, ADHD-HI, ODD and Sluggish Cognitive Tempo. Single and multiple-source Latent-State Trait measurement model (LST) analysis was applied. The results indicated discrepancies between settings, and CU-LPE turned out to be more trait-like at home and more state-like at school. 3) To analyze the categorical utility of the PE scale and its clinical application. The Item Response Theory showed that the PE scale accurately measured the characteristics of the LPE specifier even at low LPE levels. The application of a model of two IRT parameters to the PE scale (presence/absence) supported the DSM-5 criterion of the presence of two or more symptoms to determine a clinical level. The prevalence of LPE in this community sample was also similar to that described by other authors. 4) To study the evolutionary relationship between ODD and CU-LPE. The results indicated that, for fathers, mothers and primary teachers, ODD scores in 1st Grade were able to unidirectionally predict the increase in CU-LPE scores (independently from the initial level in this measure) in 4th Grade. - Conclusion: CU-LPE can be assessed with this brief PE scale, which obtained greater reliability than other brief scales. The PE scale also demonstrated structural and measurement invariance, predicted academic and social affectation for at least one of the two raters in each setting, and supported the clinical criterion of two items to assign the LPE specifier. CU-LPE also was a more setting-specific construct than other externalizing constructs, and was evolutionally associated to ODD.