Polyvagal Theory and developmental psychopathology: emotion dysregulation and conduct problems from preschool to adolescence

Abstract

In science, theories lend coherence to vast amounts of descriptive information. However, current diagnostic approaches in psychopathology are primarily atheoretical, emphasizing description over etiological mechanisms. We describe the importance of Polyvagal Theory toward understanding the etiology of emotion dysregulation, a hallmark of psychopathology. When combined with theories of social reinforcement and motivation, Polyvagal Theory specifies etiological mechanisms through which distinct patterns of psychopathology emerge. In this paper, we summarize three studies evaluating autonomic nervous system functioning in children with conduct problems, ages 4-18. At all age ranges, these children exhibit attenuated sympathetic nervous system responses to reward, suggesting deficiencies in approach motivation. By middle school, this reward insensitivity is met with inadequate vagal modulation of cardiac output, suggesting additional deficiencies in emotion regulation. We propose a biosocial developmental model of conduct problems in which inherited impulsivity is amplified through social reinforcement of emotional lability. Implications for early intervention are discussed.

Figure 1

Partial correlations between changes in heart rate and changes in RSA and PEP during reward tasks. The top panels indicate the independent effects of RSA reactivity on heart rate, controlling for PEP reactivity. The bottom panels indicate the independent effects of PEP reactivity on heart rate, controlling for RSA reactivity. Negative correlations are indicated by bars rising above the x-axis because they represent positive chronotropic effects for both RSA and PEP. RSA = respiratory sinus arrhythmia; PEP = preejection period; CD = conduct disorder; ADHD = attention-deficit/hyperactivity disorder; ODD = oppositional defiant disorder. ^*p<.05, ^**p ≤ .01.

Figure 2

Hypothesized relations between inherited biological risk for ADHD and environmental-familial risk for CD. Note that inherited impulsivity renders ADHD children at particularly high risk for future CD in the context of coercive family environments, where emotional lability is repeatedly reinforced.