Commentary: Conduct disorder and perceiving harm to others - a reflection on Michalska et al. (2016)

Children with conduct disorder (CD) persistently violate the rights of other people and represent a considerable societal cost. These children display atypically muted empathic responses to other people’s distress. Such deficient empathic processing is thought to be one predisposing factor to CD and it may partly account for the violent and antisocial behaviour of these children. Previous functional magnetic resonance imaging (fMRI) studies on adolescents with conduct problems have used a variety of tasks to investigate the neural response to other people’s distress or pain in this group (e.g. Decety et al., 2009; Lockwood et al., 2013; Marsh et al., 2013; Viding et al., 2012). These studies have, in general, indicated that atypical engagement of a number of brain areas linked with affective and empathic processing characterizes these children when they view other people in distress or pain. What is also clear is that there is considerable heterogeneity among these children. For example, previous studies have linked callous-unemotional traits in particular with lower neural responses [e.g. in amygdala, anterior insula (aINS) and anterior cingulate cortex (ACC)] to perceiving other people’s distress and pain (Lockwood et al., 2013; Marsh et al., 2013; Viding et al., 2012). Although the extant evidence base provides preliminary pointers to the neural underpinnings of CD, it is still early days for fMRI studies in this area. The study by Michalska, Zeffiro, and Decety (2016) reported in this issue of JCPP extends our knowledge in a number of important ways. First, the authors focus on a preadolescent sample of children with CD (and comparison children). There are no previous fMRI data on this age group of children with CD and their investigation enables us to ascertain whether the pattern of atypical neural reactivity seen in adolescents with CD is seen in this age group as well. Second, the authors have acquired data on a large sample of children (100+), which increases the confidence in their findings and facilitates the continuous analyses regarding CD symptom severity, callousness, and reactive aggression (RA). Investigation into heterogeneity among children who all display CD characteristics is important as we seek to understand multiple causal pathways to problem behaviour. Finally, inclusion of both boys and girls in the study sample enables, for the first time, a direct test of sex differences with regard to neural function in CD.