Psychopathy as Predictor and Moderator of Multisystemic Therapy Outcomes among Adolescents Treated for Antisocial Behavior

Objective

The aim of the present study was to determine whether psychopathic traits act as a predictor and/or moderator of the effectiveness of Multisystemic Therapy (MST).

Method

The sample included N?=?256 adolescents (188 boys and 68 girls) referred for conduct problems, randomized to MST or Treatment As Usual (TAU). The mean age was 16 years (SD?=?1.31). Assessments were carried out before and immediately after treatment (6 months later). Three psychopathic traits (callous/unemotional traits, narcissism, and impulsiveness) were assessed with parent reports. Adolescents and parents were informants on externalizing problems.

Results

MST was more effective than TAU in decreasing externalizing problems for the “lower callous/unemotional” and “lower narcissism” group, but not for the “high callous/unemotional” and “high narcissism” group (moderators). Impulsiveness was found to predict more post-treatment externalizing problems rated by adolescents (predictor), but not more post-treatment externalizing problems rated by parents.

Conclusions

These findings point out the clinical relevance of adequately assessing psychopathic traits in adolescents referred for treatment of antisocial behaviour, and identifying those adolescents who show high levels of these traits. It is important to tailor MST specifically to meet the needs of juveniles with high levels of callous/unemotional traits and high levels of narcissism to obtain the same level of effectiveness as with juveniles scoring lower on these traits.     

The Indirect Effects of Adolescent Psychopathic Traits on Aggression Through Social-Cognitive Factors

Psychopathic traits have been shown to designate youth who are at-risk for varied forms of aggression. The present study examined the indirect effects of social-cognitive factors (i.e., hostility and general approval of aggression) in the association between psychopathic traits (i.e., callous-unemotional traits, narcissism) and two functions of adolescent aggression (i.e., reactive, proactive). Participants were 209 (178 males, 31 females) adolescents aged 16 to 19 attending a residential program for youth who have dropped out of high school. Using a cross-sectional design, participants completed self-report measures of callous-unemotional traits (i.e., callousness, uncaring, unemotional), narcissism, aggression, hostility, and approval of aggression. Results indicated significant indirect effects of callousness on both functions of aggression through hostility. Similarly, there were significant indirect effects of narcissism on both functions of aggression through hostility. Significant indirect effects were also evident for general approval of aggression in the relations between callous-unemotional traits (both callous and uncaring dimensions) and both functions of aggression, and between narcissism and both functions of aggression. These results suggest the importance of examining social-cognitive processes insofar as they may contribute to the relation between psychopathic traits and aggression in youth and serve as possible targets of intervention.     

Linking Callous-Unemotional Traits to Instrumental and Non-Instrumental Forms of Aggression

The current study investigated the relation of callous-unemotional (CU) traits to bullying, victimization, and proactive and reactive aggression. We also examined whether CU traits will be more strongly related to groups of children exhibiting combined or pure forms of proactive and reactive aggression and combined or pure forms of bullying and victimization. The findings suggested that the presence of CU traits, which consists of three dimensions of behavior, uncaring, callousness, and unemotional, may designate important subgroups of aggressive children. Evidence suggested that the adolescents characterized by higher levels of CU traits were more likely to exhibit combined proactive and reactive aggression in comparison to pure forms of proactive or reactive aggression. Additionally, bullies scored higher on the uncaring dimension, and bully-victims (adolescents exhibiting both bullying and victimization) scored higher on the callous dimension. In contrast, victims of bullying scored lower on the uncaring dimension of behavior.     

Gender, Somatization, and Psychopathic Traits in a College Sample

The structure of psychopathic traits and their association with somatization symptoms were investigated in a sample of 199 undergraduate college students enrolled in introductory psychology classes. Using multiple measures of psychopathic traits, an iterated principal axis (IPA) analysis revealed two dimensions of psychopathy that were similar to ones typically found in forensic samples. One dimension focused on a cold, callous, and unemotional interpersonal style and the second dimension focused on an impulsive and antisocial lifestyle. These two dimensions emerged for both men and women, although the correlation between the two was somewhat higher for men than women. Also, the callous and unemotional dimension was negatively correlated with somatization symptoms, and the impulsive and antisocial dimension was positively associated with somatization symptoms. This pattern of associations was similar for both men and women and it suggests that somatization symptoms may be one aspect of the high rate of negative affectivity experienced by antisocial individuals.     

The Association between Anxiety and Psychopathy Dimensions in Children

Although several theoretical models posit that low levels of anxiety are a risk factor for psychopathy and antisocial behavior, a number of studies have reported elevated levels of anxiety among antisocial individuals. Nevertheless, most investigators in this literature have not distinguished between fearfulness and trait anxiety or attempted to separate the antisocial lifestyle dimension from the callous and unemotional dimension of psychopathy. In a study of clinically referred children (N = 143), we found that (a) measures of trait anxiety and fearlessness (low fearfulness) exhibited low correlations; (b) conduct problems tended to be positively correlated with trait anxiety, whereas callous and unemotional traits tended to be negatively correlated with trait anxiety; and (c) controlling statistically for the effects of one dimension increased the divergent correlations of the other dimension with both trait anxiety and fearful inhibition. These findings bear potentially important implications for the diagnosis and etiology of psychopathy and antisocial behavior and suggest that distinctions between trait anxiety and fearful inhibition, as well as between the two dimensions of psychopathy, may help to clarify longstanding confusion in this literature.     

Psychopathic Traits of Dutch Adolescents in Residential Care: Identifying Subgroups

The present study examined whether a sample of 214 (52.8% male, M age = 15.76, SD = 1.29) institutionalized adolescents could be classified into subgroups based on psychopathic traits. Confirmatory Factor Analyses revealed a relationship between the subscales of the Youth Psychopathic traits Inventory (YPI) and the three latent constructs of the original model on which it is based. Latent Class Analyses showed that adolescents showing psychopathic traits could be classified into three subgroups. The first group showed low scores on the grandiose/manipulative dimension, the callous/unemotional dimension, and the impulsive/irresponsible dimension (normal group). The second group scored moderate on the grandiose/manipulative dimension and the callous/unemotional dimension and high on the impulsive/irresponsible dimension (impulsive, non-psychopathic-like group). The third group scored high on all three dimensions (psychopathy-like group). The findings revealed that the impulsive, non-psychopathic like group scored significantly higher on internalizing problem behavior compared to the normal group, while the psychopathy-like and the impulsive, non-psychopathic-like group both scored higher on externalizing problem behavior compared to the normal group. Based on a self-report delinquency measure, it appeared that the psychopathy-like group had the highest delinquency rates, except for vandalism. Both the impulsive and psychopathy-like group had the highest scores on the use of soft drugs.     

Parenting stress, perceived parenting behaviors, and adolescent self-concept in European American families

This study assesses whether the stresses associated with parenting a child are indirectly related to adolescent self-concept through parenting behaviors. We examined longitudinal associations among mothers' and fathers' parenting stress at age 10, children's perceptions of parenting at age 10, and adolescents' self-concept at age 14 in 120 European American families. Mothers' and fathers' parenting stress was related to children's perceptions of acceptance and psychologically controlling behavior, and psychologically controlling behavior (and lax control for fathers) was related to adolescent self-concept. We further examined which domains of parenting stress and perceived parenting behaviors were associated with adolescents' scholastic competence, social acceptance, physical appearance, and behavioral conduct. Parenting stress was related to specific parenting behaviors, which were, in turn, related to specific domains of self-concept in adolescence. Parenting stress appears to exert its effects on early adolescent self-concept indirectly through perceived parenting behavior.     

Internalizing problems and their impact on the relation between callous-unemotional traits,narcissism, and aggression

Narcissism and callous-unemotional (CU) traits have demonstrated relations with youth aggression across studies. However, different forms of narcissism and internalizing problems may exacerbate the relation between CU traits and aggression. To that end, the current study examined the degree to which interactions among internalizing problems, CU traits, and dimensions of narcissism related to aggression in a sample of 219 adolescents (83.1% males), ages 16–19, enrolled in a military-style residential program. Consistent with previous research, psychopathy-linked narcissism significantly moderated the relation between CU traits and aggression. Addtionally, self-reported aggression was highest among adolescents who endorsed high levels of CU traits, psychopathy-linked narcissism, and internalizing problems. The same pattern of results was not evident for other forms of narcissism. These results suggest that internalizing problems further increase the probability of aggression among adolescents with psychopathic tendencies (i.e., CU traits, psychopathy-linked narcissism). Further implications are discussed.     

A genetic factor explains most of the variation in the psychopathic personality

The psychopathic personality can be conceptualized as three interrelated dimensions, (a) an interpersonal style of glibness, grandiosity, and manipulation; (b) an affective disposition of callousness, lack of empathy, and unemotionality; and (c) a behavioral/lifestyle dimension of impulsivity, need for stimulation, and irresponsibility, underpinning a higher order construct, psychopathic personality. The authors used a self-report questionnaire (The Youth Psychopathic Traits Inventory) to study the importance of genetic and environmental influences on psychopathic personality traits in a sample of 1,090 monozygotic and dizygotic twin pairs, aged 16-17 years. Results showed a strong genetic influence behind the higher order "psychopathic personality" factor, underpinned by the three psychopathic personality dimensions. Over and above the effects to the higher order factor, significant unique genetic influences were also found in the callous/unemotional and in the impulsive/irresponsible dimension, but not in the grandiose/manipulative dimension. The authors propose that this latent psychopathic personality factor is a meaningful target for future etiological research.     

The importance of narcissism in predicting proactive and reactive aggression in moderately to highly aggressive children

The present study examined the importance of psychopathy-linked narcissism in predicting proactive and reactive aggression and conduct problems in a group of 160 moderately to highly aggressive children (mean age of 10 years, 9 months). Children's self-report of self-esteem and parent and teacher report of dimensions of psychopathy [narcissism, callous-unemotional (CU) traits, and impulsivity], proactive and reactive aggression, and conduct problems were collected. Composites of parent and teacher ratings of children's behavior were used. Consistent with the study's hypotheses, narcissism predicted unique variance in both proactive and reactive aggression, even when controlling for other dimensions of psychopathy, demographic variables associated with narcissism, and the alternative subtype of aggression. As hypothesized, impulsivity was significantly associated with only reactive aggression. CU traits were not related to proactive or reactive aggression once the control variables were entered. All dimensions of psychopathy predicted unique variance in conduct problems. Consistent with prediction, narcissism was not significantly related to general self-esteem, providing support that narcissism and self-esteem are different constructs. Furthermore, narcissism and self-esteem related differentially to proactive aggression, reactive aggression, and conduct problems. Furthermore, narcissism but not self-esteem accounted for unique variance in aggression and conduct problems. The importance of narcissism in the prediction of aggressive behaviors and clinical implications are discussed.     

Parenting stress in parents of children with attention-deficit hyperactivity disorder and parents of children with learning disabilities

Parenting a child with ADHD can challenge parenting resources and coping. Increasingly, researchers are examining the relationship between the behavior of the child with ADHD and family functioning. While studies have shown inceased parenting stress in parents of children with ADHD, these studies have compared children with ADHD to non-disabled children. This study compares reports of parenting stress among mothers of children with ADHD, mothers of children with learning disabilities and mothers of non-referred children. Results showed that parenting stress was highest for mothers of children with ADHD. Increased parenting stress was associated with child characteristics and, in particular, with externalizing behavior problems.     

Entwicklungspsychologische Aspekte von Delinquenz

Children and adolescents are more likely to present aggressive behavior than adults. According to official criminal statistics in Germany approximately one quarter of all delinquents are younger than 25 years. Nevertheless, delinquency is a transient phenomenon in adolescence and the prevalence of delinquency in young adults decreases significantly. Most children show no problems with aggressive behavior or delinquency and only persistent problems with aggressive behavior, violence and conduct problems indicate the necessity for child and adolescent psychiatric diagnostics. The type of aggression (proactive versus reactive) a child presents seems to be predictive for the later outcome and children with proactive aggression are at higher risk for later delinquency and social problems. Lack of empathy and psychopathic traits are further aspects which are of interest in research on etiology of aggressive behavior in children. Both seem to be relevant as predictors of the course of aggressive behavior. Furthermore, attachment problems in infancy, parenting style and ecological factors, such as socioeconomic status and peers have an influence both on the origin and on the course of aggressive behavior in children.     

Psychopathic Traits and Delinquency Trajectories in Adolescence

The utility of psychopathic traits predicting various forms of antisocial behavior has been demonstrated extensively. However, there are mixed results concerning which of the three psychopathic personality dimensions—callous and unemotional traits, grandiose and manipulative interpersonal style, impulsive-irresponsible behavior—is the best predictor of antisocial behavior in adolescence. In this study, we examined developmental trajectories of antisocial behavior over four years in adolescence and psychopathic traits as predictors of these trajectories. Participants were 811 adolescents from a longitudinal community sample (M _age = 14). Results showed that four trajectories described the development of antisocial behavior from early to middle adolescence in the current sample. Both grandiose-manipulative traits and impulsive-irresponsible behavior were significant predictors of the high and elevated trajectories whereas callous-unemotional traits were not. Our findings underline the importance of studying the dimensions of the psychopathy constructs uniquely and independently of each other.     

Dark triad personality traits and theory of mind among school-age children

This study examined the associations between four personality dimensions associated with the dark triad (callous–unemotional traits, narcissism, impulsivity, and Machiavellianism) and theory of mind (TOM) abilities among 146 middle school children. Results of hierarchical multiple regression analyses showed narcissism to be positively associated with TOM, callous–unemotional (CU) traits to be negatively associated with TOM, and impulsivity and Machiavellianism to be unrelated to TOM. No significant interactions were found between gender and any of the dimensions of personality. The putative mechanisms linking each personality dimension with understanding of mental states in others are discussed, along with directions for future research.     

Parenting Stress through the Lens of Different Clinical Groups: a Systematic Review & Meta-Analysis

Research has demonstrated an association between parenting stress and child behavior problems, and suggested levels of parenting stress are higher among parents of children at risk for behavior problems, such as those with autism and developmental delay (ASD/DD). The goal of the present study was to conduct a systematic review of parenting stress and child behavior problems among different clinical groups (i.e., ASD/DD, chronic illness, with or at-risk for behavioral and/or mood disorders). We also examined demographic and methodological variables as moderators and differences in overall levels of parenting stress between the clinical groups. This systematic review documents a link between parenting stress and child behavior problems with an emphasis on externalizing behavior. One-hundred thirty-three studies were included for quantitative analysis. Parenting stress was more strongly related to child externalizing (weighted ES r = 0.57, d = 1.39) than internalizing (weighted ES r = 0.37, d = 0.79) problems. Moderation analyses indicated that the association between parenting stress and behavior problems was stronger among studies which had mostly male and clinic-recruited samples. Overall, parenting stress levels were higher for parents of children with ASD/DD compared to parents of children from other clinical groups. Findings document the association between parenting stress and child behavior problems and highlight the importance of assessing parenting stress as part of routine care and throughout behavioral intervention programs, especially for groups of children at high risk for behavior problems, such as children with ASD/DD, in order to identify support for both the parent(s) and child.     

Higher cortisol is associated with poorer executive functioning in preschool children: The role of parenting stress,parent coping and quality of daycare

Child executive functions (cognitive flexibility, inhibitory control, working memory) are key to success in school. Cortisol, the primary stress hormone, is known to affect cognition; however, there is limited information about how child cortisol levels, parenting factors and child care context relate to executive functions in young children. The aim of this study was to examine relationships between child cortisol, parenting stress, parent coping, and daycare quality in relation to executive functions in children aged 3–5 years. We hypothesized that (1) poorer executive functioning would be related to higher child cortisol and higher parenting stress, and (2) positive daycare quality and positive parent coping style would buffer the effects of child cortisol and parenting stress on executive functions. A total of 101 children (53 girls, 48 boys, mean age 4.24 years ±0.74) with complete data on all measures were included. Three saliva samples to measure cortisol were collected at the child’s daycare/preschool in one morning. Parents completed the Behavior Rating Inventory of Executive Function – Preschool Version (BRIEF-P), Parenting Stress Index (PSI), and Ways of Coping Questionnaire (WCQ). The Early Childhood Environment Rating Scale – Revised (ECERS-R) was used to measure the quality of daycare. It was found that children with poorer executive functioning had higher levels of salivary cortisol, and their parents reported higher parenting stress. However, parent coping style and quality of daycare did not modulate these relationships. Identifying ways to promote child executive functioning is an important direction for improving school readiness.     

Parental Invalidation and the Development of Narcissism

Parenting behaviors and childhood experiences have played a central role in theoretical approaches to the etiology of narcissism. Research has suggested an association between parenting and narcissism; however, it has been limited in its examination of different narcissism subtypes and individual differences in parenting behaviors. This study investigates the influence of perceptions of parental invalidation, an important aspect of parenting behavior theoretically associated with narcissism. Correlational and hierarchical regression analyses were conducted using a sample of 442 Australian participants to examine the relationship between invalidating behavior from mothers and fathers, and grandiose and vulnerable narcissism. Results indicate that stronger recollections of invalidating behavior from either mothers or fathers are associated with higher levels of grandiose and vulnerable narcissism when controlling for age, gender, and the related parenting behaviors of rejection, coldness, and overprotection. The lowest levels of narcissism were found in individuals who reported low levels of invalidation in both parents. These findings support the idea that parental invalidation is associated with narcissism.     

Are Callous Unemotional (CU) Traits Enough?

A guiding question for this special section, sparked by the increasing number of studies on callous –unemotional traits (CU traits) and the DSM-5 Limited Prosocial Emotion (LPE) specifier, is whether CU traits are enough to identify a clinically meaningful subgroup of youth with conduct problems or whether other psychopathic traits contribute. Seven empirical papers and two commentary papers address this question to varying degrees and in different ways with some papers “competing” various models against one another along with other papers investigating distinct correlates of the psychopathy factors. Findings across the papers suggest that there could be benefits to examining the broader construct of psychopathy in addition to examining its underpinning dimensions rather than CU traits alone. Two commentary papers also shed light on the importance of psychopathic traits in children with Conduct Disorder (CD) and provide insights for future work on this topic. It is hoped that the articles and commentary will generate new ideas for research and practice that could have implications for the treatment of those individuals with CD and psychopathic traits.     

Moral Emotions,Emotion Self-Regulation,Callous-Unemotional Traits,and Problem Behavior in Children of Incarcerated Mothers

Children with incarcerated mothers are at high risk for developing problem behaviors. Fifty children (6–12 years; 62% girls) participated in summer camps, along with adult mentors. Regression analyses of child and adult measures of child’s emotion self-regulation and callous-unemotional traits, and a child measure of moral emotions, showed that poor emotion regulation, along with low levels of guilt and high levels of shame, predicted children’s externalizing behaviors, while only low levels of guilt predicted a unique subset of child characteristics called callous-unemotional traits. Children who experienced healthy guilt for misdeeds were better able to control their behavior. Adults noted the ability of children with callous/unemotional traits to manage and regulate their emotions, while poor emotion regulation was more predictive of the cluster of externalizing problems. Discussion focuses on prevention efforts aimed at teaching emotion self-regulation and the implications of the high levels of callous-unemotional traits in this population of children.