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      The Role of Executive Functions in the Development of Empathy and Its Association with Externalizing Behaviors in Children with Neurodevelopmental Disorders and Other Psychiatric Comorbidities

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          Abstract

          Executive functions have been previously shown to correlate with empathic attitudes and prosocial behaviors. People with higher levels of executive functions, as a whole, may better regulate their emotions and reduce perceived distress during the empathetic processes. Our goal was to explore the relationship between empathy and executive functioning in a sample of children and adolescents diagnosed with Attention Deficit and Hyperactivity Disorder alone or associated with comorbid Disruptive Behavior Disorders and/or Autism Spectrum Disorder. We also aimed to examine the role of empathic dimensions and executive skills in regulating externalizing behaviors. The 151 participants with ADHD were assigned to four groups according to their psychiatric comorbidity (either “pure” or with ASD and/or ODD/CD) and assessed by means of either parent- or self-reported questionnaires, namely the BRIEF−2, the BES, and the IRI. No questionnaire was found to discriminate between the four groups. Affective Empathy was found to positively correlate with Emotional and Behavioral Regulation competences. Furthermore, Aggressiveness and Oppositional Defiant Problems were positively associated with Executive Emotional and Behavioral Regulation competences. On the other hand, Rule-Breaking Behaviors and Conduct Problems were negatively associated with Affective Empathy and with Behavioral skills. Our study provides an additional contribution for a better understanding of the complex relationship between empathic competence and executive functions, showing that executive functioning and empathic attitudes interact with each other to regulate aggressive behaviors. This study further corroborates developmental models of empathy and their clinical implications, for which externalizing behaviors could be attenuated by enhancing executive functioning skills.

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          Most cited references56

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          Empathic neural responses are modulated by the perceived fairness of others.

          The neural processes underlying empathy are a subject of intense interest within the social neurosciences. However, very little is known about how brain empathic responses are modulated by the affective link between individuals. We show here that empathic responses are modulated by learned preferences, a result consistent with economic models of social preferences. We engaged male and female volunteers in an economic game, in which two confederates played fairly or unfairly, and then measured brain activity with functional magnetic resonance imaging while these same volunteers observed the confederates receiving pain. Both sexes exhibited empathy-related activation in pain-related brain areas (fronto-insular and anterior cingulate cortices) towards fair players. However, these empathy-related responses were significantly reduced in males when observing an unfair person receiving pain. This effect was accompanied by increased activation in reward-related areas, correlated with an expressed desire for revenge. We conclude that in men (at least) empathic responses are shaped by valuation of other people's social behaviour, such that they empathize with fair opponents while favouring the physical punishment of unfair opponents, a finding that echoes recent evidence for altruistic punishment.
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            Hot and Cool Executive Function in Childhood and Adolescence: Development and Plasticity

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              The amygdala and ventromedial prefrontal cortex in morality and psychopathy.

              R. Blair (2007)
              Recent work has implicated the amygdala and ventromedial prefrontal cortex in morality and, when dysfunctional, psychopathy. This model proposes that the amygdala, through stimulus-reinforcement learning, enables the association of actions that harm others with the aversive reinforcement of the victims' distress. Consequent information on reinforcement expectancy, fed forward to the ventromedial prefrontal cortex, can guide the healthy individual away from moral transgressions. In psychopathy, dysfunction in these structures means that care-based moral reasoning is compromised and the risk that antisocial behavior is used instrumentally to achieve goals is increased.
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                Author and article information

                Journal
                Brain Sci
                Brain Sci
                brainsci
                Brain Sciences
                MDPI
                2076-3425
                28 July 2020
                August 2020
                : 10
                : 8
                : 489
                Affiliations
                [1 ]IRCCS Stella Maris Foundation, 56128 Pisa (Calambrone), Italy; ccristofani@ 123456fsm.unipi.it (C.C.); gsesso@ 123456fsm.unipi.it (G.S.); pcristofani@ 123456fsm.unipi.it (P.C.); pfantozzi@ 123456fsm.unipi.it (P.F.); einguaggiato@ 123456fsm.unipi.it (E.I.); pmuratori@ 123456fsm.unipi.it (P.M.); anarzisi@ 123456fsm.unipi.it (A.N.); cpfanner@ 123456fsm.unipi.it (C.P.); lpolidori@ 123456fsm.unipi.it (L.P.); lruglioni@ 123456fsm.unipi.it (L.R.); evalente@ 123456fsm.unipi.it (E.V.); gmasi@ 123456fsm.unipi.it (G.M.)
                [2 ]Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
                [3 ]Department of Neuroscience, AORN Santobono-Pausilipon, 80122 Naples, Italy; pisano.simone@ 123456gmail.com
                [4 ]Department of Translational Medical Sciences, Federico II University, 80138 Naples, Italy
                Author notes
                [†]

                These authors contributed equally to this work.

                Author information
                https://orcid.org/0000-0001-7779-779X
                https://orcid.org/0000-0002-6970-3578
                https://orcid.org/0000-0001-5704-4483
                Article
                brainsci-10-00489
                10.3390/brainsci10080489
                7465618
                32731515
                c89f40f3-dab1-42ef-9bd4-29404c836e9f
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 06 July 2020
                : 21 July 2020
                Categories
                Article

                empathy,executive functions,attention deficit and hyperactivity disorder,autism spectrum disorder,disruptive behavior disorders

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