Emotion Dysregulation and Externalizing Spectrum Disorders

Tiffany M Shader, Theodore P. Beauchaine
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引用次数: 1

Abstract

As described in the literature for many years, a sizable number of children with hyperactive-impulsive and combined subtypes/presentations of attention-deficit/hyperactivity disorder (ADHD)—especially males—progress to more serious externalizing syndromes across development. Such outcomes include oppositional defiant disorder, conduct problems, delinquency, substance use disorders, and in some cases antisocial personality disorder, incarceration, and recidivism. This chapter summarizes a developmental model that emphasizes different contributions of trait impulsivity, a highly heritable, subcortically mediated vulnerability, versus emotion dysregulation, a highly socialized, cortically mediated vulnerability, to externalizing progression. According to this perspective, trait impulsivity confers vulnerability to all externalizing disorders, but this vulnerability is unlikely to progress beyond ADHD in protective environments. In contrast, for children who are reared under conditions of adversity—including poverty, family violence, deviant peer influences, and neighborhood violence/criminality—neurodevelopment of prefrontal cortex structure and function is compromised, resulting in failures to achieve age-expected gains in emotion regulation and other forms of executive control. For these children, subcortical vulnerabilities to trait impulsivity are amplified by deficient cortical modulation, which facilitates progression along the externalizing spectrum.
情绪失调与外化谱系障碍
正如多年来的文献所描述的那样,相当数量的患有多动症-冲动型和注意力缺陷/多动障碍(ADHD)合并亚型/表现的儿童——尤其是男性——在整个发展过程中会发展成更严重的外化综合征。这些结果包括对立违抗性障碍、行为问题、犯罪、物质使用障碍,在某些情况下还包括反社会人格障碍、监禁和再犯。本章总结了一个发展模型,该模型强调特质冲动性(一种高度遗传的、皮层下介导的脆弱性)与情绪失调(一种高度社会化的、皮层介导的脆弱性)对外化进程的不同贡献。根据这一观点,冲动性特质赋予了所有外化障碍的脆弱性,但这种脆弱性不太可能在保护环境中超越ADHD。相比之下,在逆境条件下长大的儿童——包括贫困、家庭暴力、异常同伴影响和邻里暴力/犯罪——前额叶皮层结构和功能的神经发育受到损害,导致他们在情绪调节和其他形式的执行控制方面无法达到预期的年龄增长。对于这些儿童来说,皮层下对特质性冲动的脆弱性因皮层调节缺陷而被放大,这促进了外化谱的发展。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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