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

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.

Below: 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).