A Behavioral Measure of Costly Helping: Replicating and Extending the Association with Callous Unemotional Traits in Male Adolescents

Joseph T Sakai, Manish S Dalwani, Susan K Mikulich-Gilbertson, Shannon K McWilliams, Kristen M Raymond, Thomas J Crowley, Joseph T Sakai, Manish S Dalwani, Susan K Mikulich-Gilbertson, Shannon K McWilliams, Kristen M Raymond, Thomas J Crowley

Abstract

Background: Some conduct-disordered youths have high levels of callous unemotional traits and meet the DSM-5's "with limited prosocial emotions" (LPE) specifier. These youths often do aggressive, self-benefitting acts that cost others. We previously developed a task, the AlAn's game, which asks participants to repeatedly decide whether to accept or reject offers in which they will receive money but a planned charity donation will be reduced. In our prior work, more "costly helping" (i.e., rejecting the offered money and protecting the donation) was associated with lower callous unemotional traits. Here we extend that prior work in a larger sample of adolescent male patients with serious conduct problems and controls, and test whether this association is mediated specifically by a Moral Elevation response (i.e., a positive emotional response to another's act of virtue).

Methods: The adolescent male participants were: 45 patients (23 with LPE) and 26 controls, who underwent an extensive phenotypic assessment including a measure of Moral Elevation. About 1 week later participants played the AlAn's game.

Results: All AlAn's game outcomes demonstrated significant group effects: (1) money taken for self (p = 0.02); (2) money left in the charitable donation (p = 0.03); and, (3) costly helping (p = 0.047). Controls took the least money and did the most costly helping, while patients with LPE took the most money and did the least costly helping. Groups also significantly differed in post-stimulus Moral Elevation scores (p = 0.005). Exploratory analyses supported that the relationship between callous unemotional traits and costly helping on the AlAn's game may be mediated in part by differences in Moral Elevation.

Conclusions: The AlAn's game provides a standardized behavioral measure associated with callous unemotional traits. Adolescents with high levels of callous unemotional traits engage in fewer costly helping behaviors, and those differences may be related to blunting of positive emotional responses.

Conflict of interest statement

Competing Interests: T. Crowley recently served on the National Advisory Council of the National Institute on Drug Abuse, and on a Task Force of the American Psychiatric Association for drafting the Diagnostic and Statistical Manual of Mental Disorders, Edition 5. Dr. Sakai received reimbursement in 2012 for completing a policy review for the WellPoint Office of Medical Policy & Technology Assessment (OMPTA), WellPoint, Inc., Thousand Oaks, CA. He also served as a board member of the ARTS (Addiction Research and Treatment Services) Foundation. The other authors declare no competing interests. Dr. Sakai's and Crowley's competing interests do not alter the authors' adherence to all PLOS ONE policies on sharing data and materials.

Figures

Fig 1. Examples of the different trial…
Fig 1. Examples of the different trial types in the AlAn’s game.
Panel A shows an Active Trial where the participant will receive 64 cents and the Red Cross donation will be reduced by 2 cents. Participants are asked to accept or reject this offer. Panel B shows an Attentional Control Trial where the participant will lose 2 cents and the Red Cross donation will be reduced by 8 cents. We term this kind of Attention Control trials, “Logically-Reject” Trials. Panel C shows an Attention Control Trial where the participant will gain 32 cents and the Red Cross donation won’t change. We term these “Logically-Accept” Trials. Panel D shows a Calculation Trial where the You number (+8) is not bigger than the Red Cross number +16). Note: The circle remains red for 5 seconds, allowing participants to view the trial content. Then the circle turns green and subjects have 1 second to press either yes (accept) vs. no (reject).
Fig 2. Results from the AlAn’s Game…
Fig 2. Results from the AlAn’s Game in-magnet study (left panel) and results from the previously published out-of-magnet study (right panel).
Error bars indicate standard error. Money taken for self in blue and money left in the Red Cross donation in orange.
Fig 3
Fig 3
Aggregate Elevation Scores Prior to (Panel A) and Post-stimulus Administration (Panel B); error bars indicate standard errors. Mediation Model, testing whether Elevation mediates the association between level of Callous Unemotional Traits and AlAn’s Game behavior (Panel C). Bracket above bars indicates ANOVA was significant for group differences; * p

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