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KAUI, HAWAII – Preschoolers at genetic risk for antisocial behavior may benefit from family-based preventive intervention, Dr. Glen O. Gabbard said at the annual meeting of the American College of Psychiatrists.
“I worked in the prison system for 6 years. One of the things you see again and again is that antisocial patients are not very responsive to individual therapy,” he said.
If they don't receive any treatment until they are adults, “you're not going to get anywhere with them,” said Dr. Gabbard, Brown Foundation Professor of Psychoanalysis and professor of psychiatry at Baylor College of Medicine, Houston. “We need to start thinking about early preventive approaches based on family therapy models.”
In a recent study that he discussed, investigators enrolled 92 preschoolers who were considered to be at substantial genetic risk for antisocial behavior because they had siblings with a history of juvenile delinquency (Arch. Gen. Psychiatry 2007;64:1172-9).
The children were randomized to one of two groups. In the family-intervention group, the preschoolers and their parents had 22 weekly group sessions and 10 biweekly home visits over a 6- to 8-month period. The control group received assessments and monthly telephone calls. Salivary cortisol levels were measured as an indicator of response to stress.
Since salivary cortisol levels are lower in people who exhibit antisocial behavior and have conduct problems, “the thought here is that maybe the early-life experience can alter cortisol release,” he noted.
Compared with the control group, children who had undergone family-based intervention had increased salivary cortisol levels when faced with entry into an unfamiliar group of peers. “Something changed in their reading of social groups so that they had more anxiety,” Dr. Gabbard said.
“The antisocial patient doesn't engage the amygdala in the way that a borderline patient does,” he observed. The antisocial patient has “less of a fear response.” Family-based preventive intervention may play a role in boosting activation of the amygdala and modifying the hypothalamic-pituitary-adrenal axis when someone is faced with a threatening situation, he said.
“Preventive family therapy may give us some hope in what has been a rather dismal history of treating the psychopathic or antisocial patient,” said Dr. Gabbard, who disclosed no relevant conflicts.
Preventive family therapy might play a role in boosting activation of the amygdala. DR. GABBARD
KAUI, HAWAII – Preschoolers at genetic risk for antisocial behavior may benefit from family-based preventive intervention, Dr. Glen O. Gabbard said at the annual meeting of the American College of Psychiatrists.
“I worked in the prison system for 6 years. One of the things you see again and again is that antisocial patients are not very responsive to individual therapy,” he said.
If they don't receive any treatment until they are adults, “you're not going to get anywhere with them,” said Dr. Gabbard, Brown Foundation Professor of Psychoanalysis and professor of psychiatry at Baylor College of Medicine, Houston. “We need to start thinking about early preventive approaches based on family therapy models.”
In a recent study that he discussed, investigators enrolled 92 preschoolers who were considered to be at substantial genetic risk for antisocial behavior because they had siblings with a history of juvenile delinquency (Arch. Gen. Psychiatry 2007;64:1172-9).
The children were randomized to one of two groups. In the family-intervention group, the preschoolers and their parents had 22 weekly group sessions and 10 biweekly home visits over a 6- to 8-month period. The control group received assessments and monthly telephone calls. Salivary cortisol levels were measured as an indicator of response to stress.
Since salivary cortisol levels are lower in people who exhibit antisocial behavior and have conduct problems, “the thought here is that maybe the early-life experience can alter cortisol release,” he noted.
Compared with the control group, children who had undergone family-based intervention had increased salivary cortisol levels when faced with entry into an unfamiliar group of peers. “Something changed in their reading of social groups so that they had more anxiety,” Dr. Gabbard said.
“The antisocial patient doesn't engage the amygdala in the way that a borderline patient does,” he observed. The antisocial patient has “less of a fear response.” Family-based preventive intervention may play a role in boosting activation of the amygdala and modifying the hypothalamic-pituitary-adrenal axis when someone is faced with a threatening situation, he said.
“Preventive family therapy may give us some hope in what has been a rather dismal history of treating the psychopathic or antisocial patient,” said Dr. Gabbard, who disclosed no relevant conflicts.
Preventive family therapy might play a role in boosting activation of the amygdala. DR. GABBARD
KAUI, HAWAII – Preschoolers at genetic risk for antisocial behavior may benefit from family-based preventive intervention, Dr. Glen O. Gabbard said at the annual meeting of the American College of Psychiatrists.
“I worked in the prison system for 6 years. One of the things you see again and again is that antisocial patients are not very responsive to individual therapy,” he said.
If they don't receive any treatment until they are adults, “you're not going to get anywhere with them,” said Dr. Gabbard, Brown Foundation Professor of Psychoanalysis and professor of psychiatry at Baylor College of Medicine, Houston. “We need to start thinking about early preventive approaches based on family therapy models.”
In a recent study that he discussed, investigators enrolled 92 preschoolers who were considered to be at substantial genetic risk for antisocial behavior because they had siblings with a history of juvenile delinquency (Arch. Gen. Psychiatry 2007;64:1172-9).
The children were randomized to one of two groups. In the family-intervention group, the preschoolers and their parents had 22 weekly group sessions and 10 biweekly home visits over a 6- to 8-month period. The control group received assessments and monthly telephone calls. Salivary cortisol levels were measured as an indicator of response to stress.
Since salivary cortisol levels are lower in people who exhibit antisocial behavior and have conduct problems, “the thought here is that maybe the early-life experience can alter cortisol release,” he noted.
Compared with the control group, children who had undergone family-based intervention had increased salivary cortisol levels when faced with entry into an unfamiliar group of peers. “Something changed in their reading of social groups so that they had more anxiety,” Dr. Gabbard said.
“The antisocial patient doesn't engage the amygdala in the way that a borderline patient does,” he observed. The antisocial patient has “less of a fear response.” Family-based preventive intervention may play a role in boosting activation of the amygdala and modifying the hypothalamic-pituitary-adrenal axis when someone is faced with a threatening situation, he said.
“Preventive family therapy may give us some hope in what has been a rather dismal history of treating the psychopathic or antisocial patient,” said Dr. Gabbard, who disclosed no relevant conflicts.
Preventive family therapy might play a role in boosting activation of the amygdala. DR. GABBARD