Unique and Interactive Associations of Callous-Unemotional Traits,Impulsivity and Grandiosity with Child and Adolescent Conduct Disorder Symptoms

The construct of psychopathy remains underrepresented in the clinical diagnosis of Conduct Disorder (CD) as the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) only addresses one out of the three dimensions of child psychopathy, Callous Unemotional (CU) traits. This study tests if and to what extent there are unique and interactive associations of CU traits, impulsivity, and grandiosity with child and adolescent CD symptoms. Data were collected from two separate community samples of children (N?=?1599; Mage?=?9.46, SD?=?1.65; 52% female) and adolescents (N?=?2719; Mage?=?16.99, SD?=?0.99; 49% female), who were followed longitudinally after a year. Hierarchical linear regression analyses were conducted, testing cross-sectional and longitudinal associations with CD symptoms, taking into account all three psychopathy dimensions. The cross-sectional findings indicate that only youth presenting a combination of all three psychopathy dimensions scored above the clinical cut-off score for CD. On the other hand, longitudinal findings provided evidence that the combination of high initial levels of CD and CU traits as well as the combination between CD, grandiosity, and impulsivity can lead to clinical levels of future CD symptoms. Findings also indicated that CU traits and impulsivity more strongly predicted adolescent than child CD symptoms, and that CU traits were more strongly associated with boys’ than girls’ CD symptoms. Findings support the inclusion of CU traits as a specifier for the diagnosis of CD, and provide evidence that other psychopathy dimensions can also help clinicians to better understand and treat youth with CD, and should be considered for future revisions of the DSM.     

Callous-Unemotional Traits and Subtypes of Conduct Disorder

There has been growing consensus that children with conduct disorder (CD) constitute a very heterogeneous group containing children who vary substantially on the development, course, and causes of the disorder. While many have recognized the importance of this heterogeneity for developing better causal theories and for developing more effective treatments, there has been little consensus as to the best way to subtype children with CD. In this paper, we review a number of approaches to subtyping, each with some evidence for its validity for certain purposes. We focus on two recent approaches that have great potential for integrating past subtyping approaches and for advancing causal theory. The first approach is the division of children with CD into those with a childhood onset to their severe antisocial behavior and those with an adolescent onset to their behavior. The second approach is to designate children within the childhood-onset group who show callous and unemotional traits, which is analogous to adult conceptualizations of psychopathy. Both approaches help designate children who many show different causal processes underlying their severe aggressive and antisocial behavior, and who may warrant different approaches to treatment.     

Network Structure of Callous-Unemotional Traits and Conduct Disorder Symptoms Among At-Risk Youth: Multi-Informant Reports and Gender Differences

Research on Child and Adolescent Psychopathology - Network analytic techniques examine how items used to measure underlying constructs are related to one another and identify core characteristics....     

Predicting the Stability of Conduct Problems in Children with and Without Callous-Unemotional Traits

We tested predictors of persistence in conduct problems for children with and without callous-unemotional (CU) traits. Participants were 79 children of an original 98 children recruited from a community-wide screening to oversample children with conduct problems and to ensure equal numbers of children high and low on CU traits. The sample was reassessed at four yearly intervals and the 79 children (81%) were those with data at all four assessments. Children within each conduct problem group were divided into those with more and less stable patterns of conduct problems based on structured interviews with parent and child. Stability in conduct problems for children without CU traits was more strongly related to level of impulsivity and socioeconomic status, whereas children high on CU traits showed more stable conduct problems if they experienced higher rates of life stressors.     

Callous-Unemotional Traits and the Treatment of Conduct Problems in Childhood and Adolescence: A Comprehensive Review

The treatment of conduct problems among children and adolescents with callous-unemotional (CU) traits has been subject to much speculation; however, treatment outcome research has been surprisingly limited and findings have been mixed. This review examines the research to date in this field as it pertains to two key questions. First, are CU traits associated with clinical outcomes and processes in the family based treatment of child and adolescent conduct problems? Second, can family based intervention produce change in CU traits? Using a systematic search strategy, we identified 16 treatment outcomes studies that can be brought to bear on these questions. These studies provide strong evidence of unique associations between CU traits and risk for poor treatment outcomes, while at the same time indicating that social-learning-based parent training is capable of producing lasting improvement in CU traits, particularly when delivered early in childhood. We discuss the potential for this emerging evidence base to inform the planning and delivery of treatments for clinic-referred children with CU traits, and detail an ongoing program of translational research into the development of novel interventions for this high-risk subgroup.     

Roles of Callous-Unemotional Traits,Narcissism, and Machiavellianism in Childhood Aggression

This study obtained teacher ratings of impulsivity, callous-unemotional traits, narcissism, and Machiavellianism for a sample of 252 middle school children, and investigated the extent to which these variables were related to reactive versus proactive aggression and physical versus relational aggression. Results showed a main effect for gender, with boys rated highest on all measures of psychopathy and aggression, with the exception of relational aggression. Results of hierarchical multiple regressions showed that whereas impulsivity was associated with all types of aggression, CU traits, narcissism, and Machiavellianism were differentially related to specific forms of childhood aggression. In addition, Machiavellianism mediated the relationship between narcissism and relational aggression. Implications for fine-tuning interventions in ways that account for the motivators underlying subtypes of childhood aggression are discussed.     

Parenting Behavior and Conduct Problems in Children with and Without Attention-Deficit/Hyperactivity Disorder (ADHD): Moderation by Callous-Unemotional Traits

There is evidence that negative parenting positively predicts oppositional defiant disorder (ODD) and conduct disorder (CD) and that children’s callous-unemotional (CU) traits may moderate this association. However, it is largely unknown if CU traits show similar interactive effects with positive parenting for ODD/CD. 208 ethnically diverse (56% Caucasian) 6–9 year-old children with and without attention-deficit/hyperactivity disorder (ADHD) were ascertained using multiple methods and informants for ODD, CD, and CU traits. CU traits, corporal punishment, positive parenting, and each of their interactions with CU traits were unrelated to parent- and teacher-rated ODD. Corporal punishment and CU traits were similarly unrelated to parent- and teacher-rated CD. However, positive parenting inversely predicted parent-reported CD symptoms and it was significantly moderated by CU traits. Positive parenting was negatively associated with CD at low to moderate levels of CU traits, but it was unrelated to CD at high levels of CU traits. Children with elevated levels of CU traits exhibited significantly higher levels of CD symptoms that were largely independent of positive parenting behavior. We discuss these findings within a developmental psychopathology framework to provide further perspectives on reciprocal influences between parenting behavior and CU traits in the development of ODD and CD.     

Gender-specific Normative Misperceptions of Risky Sexual Behavior and Alcohol-related Risky Sexual Behavior

This research examined gender-specific perceptions of risky sexual behavior norms among college students and their relationship with one’s own sexual behavior. We expected that students would misperceive the risky sexual behavior of their peers and that these perceptions would positively relate to their sexual behavior. Undergraduate students from the United States (N?=?687; 57.6% female) completed measures assessing perceived sexual behavior, sexual behavior, and other behaviors (e.g., marijuana use, alcohol consumption). Findings demonstrated that students perceived that others engaged in more risky sexual behavior than they do and that perceived norms were positively associated with one’s own behavior. The incorporation of personalized normative feedback regarding risky sexual behavior into brief interventions aimed at reducing risky sexual behavior is discussed.     

Understanding the Covariation Among Childhood Externalizing Symptoms: Genetic and Environmental Influences on Conduct Disorder,Attention Deficit Hyperactivity Disorder,and Oppositional Defiant Disorder Symptoms

Conduct disorder (CD), attention deficit hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD) are common childhood externalizing disorders that frequently co-occur. However, the causes of their comorbidity are not well understood. To address that question, we analyzed data from > 600 Finnish twin pairs, who completed standardized interviews at age 14. Behavior genetic methods were used to examine how genetic/environmental factors contribute to each disorders symptoms and to their covariation. We found significant genetic effects on each disorder with only modest evidence of shared environmental influences. Our data suggest the comorbidity among CD, ADHD, and ODD is primarily explained by shared genetic influences; however, each disorder was also under unique genetic influence, supporting the distinction of each disorder.     

Assessment of Callous-Unemotional Traits in 6 to 12 Year-Old Children with Oppositional Defiant Disorder/Conduct Disorder by Parent Ratings

The factorial structure of the Inventory of Callous-Unemotional Traits (ICU; Frick 2004) has been inconsistent across previous studies using different rater versions (self-report, parent, teacher) and versions in different languages applied to both clinical and nonreferred samples predominantly of adolescents. The present study examined the factorial structure of the parent-report version of the ICU in a clinical sample of boys aged 6–12 years with Oppositional Defiant Disorder/Conduct Disorder (n?=?131) using confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). Results from the CFA supported previous findings, but even the preferred model with three independent factors (Callousness, Uncaring, and Unemotional) showed inadequate model fit. Subsequent EFA revealed a three-factor model consisting of two new subscales (Callousness/Lack of Guilt or Remorse, Unconcerned about Performance) and the original subscale Unemotional. Internal consistencies of the three subscales and total score were satisfactory, and intercorrelations of the subscales were weak, except for a moderate correlation between the subscales Callousness/Lack of Guilt or Remorse and Unconcerned about Performance. The corresponding subscales of the original and new versions were highly correlated. As expected, the ICU subscale Callousness/Lack of Guilt or Remorse showed associations with other measures of aggressive and oppositional behavior. The other two ICU subscales were not associated with aggression or oppositional/antisocial behavior, but Unconcerned about Performance correlated with a measure of attention problems and Unemotional correlated with the internalizing problem withdrawn. The implications of these findings are discussed, especially as a callous unemotional specifier for the diagnosis of Conduct Disorder is included in DSM-5.     

Personality Correlates of the Common and Unique Variance Across Conduct Disorder and Substance Misuse Symptoms in Adolescence

Externalising behaviours such as substance misuse (SM) and conduct disorder (CD) symptoms highly co-occur in adolescence. While disinhibited personality traits have been consistently linked to externalising behaviours there is evidence that these traits may relate differentially to SM and CD. The current study aimed to assess whether this was the case, after examining the nature of the relationship between SM and CD symptoms in an adolescent sample (N?=?392), using structural equation modelling. Similar to those found in adults (Krueger et al. Journal of Abnormal Psychology 116: 645-666, 2007), results showed that CD and SM symptoms were organized hierarchically, with symptoms explaining a single broad, coherent construct of externalising behaviour, but also explaining specific factors of SM and CD that vary independently from the general externalising factor. Furthermore, disinhibited personality traits related differentially to these factors, with results showing that, even controlling for inhibited personality traits, impulsivity was associated with CD and the common variance shared by CD and SM, while sensation seeking was specifically associated with SM only. Hopelessness was also associated with the common variance shared by SM and CD. Results confirm impulsivity, hopelessness and sensation seeking as key correlates of externalising behaviour problems in adolescence, identifying them as clear targets for intervention and prevention strategies.     

Callous-Unemotional Traits and Antisocial Behavior among Adolescents: the Role of Self-Serving Cognitions

Self-serving cognitions and callous-unemotional traits play important roles in adolescent antisocial behavior. The objective of this study was to cross-sectionally explore the mediating role of self-serving cognitions in the relationship between callous-unemotional traits and antisocial behavior. A sample of 972 high-school students completed self-report questionnaires assessing callous-unemotional traits, self-serving cognitive distortions and antisocial behavior. Two competing models exploring indirect effects accounting for the relationships between self-serving cognitive distortions, callous-unemotional traits and antisocial behaviors were tested. Both models revealed significant indirect effects, suggesting both pathways are possible. Gender was found to moderate these models. These findings suggest the importance of targeting self-serving cognitions in therapeutic interventions and increase our understanding of the role of self-serving cognitions in antisocial behavior.     

The Disruptive Adolescent as a Grown-Up: Predicting Adult Startle Responses to Violent and Erotic Films from Adolescent Conduct Problems and Callous-Unemotional Traits

The current study aimed to identify heterogeneous groups of adolescents differing on their levels of conduct problems (CP) and callous-unemotional (CU) traits, and compare them on startle reactivity to emotional videos (violent/erotic) during young adulthood. A Latent Profile Analysis, conducted among a longitudinal sample of 2306 adolescents, provided evidence for the existence of heterogeneous CP and CU subgroups (i.e., CP-only, CU-only, and CP+CU groups). Three years later, 82 young adults (Mage?=?19.95), randomly selected from the identified groups, participated in an experiment assessing their startle eye-blink responses during violent, erotic and neutral video scenes. Self-report ratings of fear, valence and arousal to affective scenes were also collected. Findings suggested that adolescents high on CP and low on CU traits showed high startle potentiation when viewing violent scenes during young adulthood, while those high on both CP and CU traits showed diminished startle reactivity to violent stimuli. Individuals high on CU traits without CP showed similar startle reactivity to controls. Further, the findings indicate that startle potentiation to violent stimuli can be a reliable physiological marker to distinguish antisocial individuals with and without CU traits. The finding that the CU only group was not differentiated from the control group on startle reactivity when viewing violent stimuli might explain their lower likelihood of engaging in antisocial behavior.     

Callous-Unemotional Traits and Effortful Control Mediate the Effect of Parenting Intervention on Preschool Conduct Problems

Parenting intervention (PI) is an effective treatment for children’s conduct problems (CP) that has been shown to be mediated by improved parenting practices and parenting self-efficacy. Recently, Hitkashrut’s randomized controlled trial demonstrated that ineffective parenting (IP) mediated effects on callous-unemotional (CU) traits and effortful control (EC), while controlling for more general treatment effects on CP. These temperament and personality-based features predict the formation of early-onset antisocial trajectories with poor long-term prognosis. The objective of this study was to use Hitkashrut’s 3-wave dataset to test posttreatment EC and CU mediation of treatment effect on 1-year follow-up CP, and to determine whether mediation by each child-level potential mediator remains significant when tested concurrently with the parenting mediator. Parents of 209 3–5 year-old preschoolers (163 boys; 46 girls), with subclinical-clinical range CP were assigned to 14-session co-parent training groups (n?=?140 couples), or to minimal intervention control groups (n?=?69 couples). Assessments were based on both parents’ questionnaires. An intent-to-treat analysis showed that EC and CU traits simultaneously mediated treatment effects on CP in one EC/CU mediational model. The concurrent testing of child- and parent-level mediators showed mediation by IP and CU traits in the CU/IP model, and IP mediation in the EC/IP model. Similar results were obtained in mediational analyses that controlled for the shared variance between the mediators and CP at T2. Overall, the findings support an intervention model of coaching parents of high-CP children to promote moral self-regulatory competencies while concurrently applying behavioral methods that directly target CP.     

Effects of Parent Training on Callous-Unemotional Traits,Effortful Control,and Conduct Problems: Mediation by Parenting

Callous-unemotional (CU) traits and effortful control (EC) are personality and temperament traits implicated in early-onset antisocial trajectories. This secondary analysis of Hitkashrut’s randomized controlled trial first tested parent training’s effects on EC and CU traits while controlling for more general treatment effects on conduct problems (CP), and subsequently tested mediation by parenting. Prekindergarten teachers in three Israeli cities identified 209 3–5 year-old (163 boys; 46 girls) preschoolers with subclinical-clinical range conduct problems. All participants were Jewish ranging from ultra-orthodox to secular. They were assigned to 14-session co-parent training groups (n = 140 couples), or to minimal intervention control groups with referral to local services as necessary (n = 69 couples). We employed averaged indices of pre- and post-intervention questionnaires completed by both parents. The testing of all hypothesized models controlled for treatment effects on CP in order to strengthen the robustness of the analyses. We found significant concurrent treatment effects on CP and on either CU traits or EC. All effects were mediated by ineffective parenting (IP): a latent variable that was indicated by negative/inconsistent practices and perceived parenting inefficacy. This is the first demonstration of parenting mediated treatment effects on both EC and CU traits in a randomized controlled study conducted in everyday practice contexts. This finding supports a disruption model of change: the reduction of IP facilitates a caregiving environment that affects children’s behavior and developing personality. The changing of personality and temperament characteristics implicated in early-onset pathways suggests an innovative prevention strategy for disruptive behavior disorders.     

Comparing Different Approaches for Subtyping Children with Conduct Problems: Callous-Unemotional Traits Only Versus the Multidimensional Psychopathy Construct

The aim of this study was to compare two youth psychopathy models (i.e., callous-unemotional versus multidimensional model) in their ability to predict future and stable conduct problems (CP). At baseline, mothers and fathers of 321 boys and 369 girls (ages 7–12) completed measures that tap callous-unemotional and other psychopathic traits. Parent-reported CP was collected at baseline and at 6- and 12 month follow-ups. Children were assigned to mutually exclusive groups based on their levels of CP and psychopathic traits. Children with CP who manifested callous-unemotional traits (Callous-Unemotional?+?CP) were occasionally at risk for future and stable CP. Yet, across gender, children with CP scoring high on all psychopathic trait dimensions (Psychopathic Personality?+?CP) showed the most robust and highest risk for future and stable CP. Also, Callous-Unemotional?+?CP children, and children who were only high in CP, often were at similar risk for future CP. The findings suggest that the callous-unemotional model is less sufficient than the multidimensional model in predicting future and stable CP. This can be concluded for both boys and girls and calls for more research reconsidering the multidimensional nature of psychopathy for CP subtyping purposes.