Attention-deficit/hyperactivity disorder and callous-unemotional traits as moderators of conduct problems when examining impairment and aggression in elementary school children

Examined whether attention-deficit/hyperactivity disorder (ADHD) and callous-unemotional (CU) traits moderate the association between conduct problems (CPs) and impairment and aggression. Participants were 214 children who were rated by their elementary school classroom teachers. Results indicated that the association between CP and impairment and aggressive outcomes is almost always moderated by ADHD and/or CU. Moreover, in many instances, the association between CP and outcomes was moderated by both ADHD and CU such that the moderating effects of CU on CP were more pronounced at lower levels of ADHD. Results are discussed with respect to developmental taxonomies and trajectories of the disruptive behavior disorders.     

Treatment Response in CP/ADHD Children with Callous/Unemotional Traits

The current study examines the role of callous/unemotional (CU) traits in response to treatment among children with conduct problems (CP) and attention-deficit/hyperactivity disorder (ADHD). Fifty-four children with CP/ADHD and 16 controls (age = 9.48, SD = 1.58) took part in a summer treatment and research program. Simple correlations showed that CU and CP were associated with a number of treatment outcome measures. When examined together in regression analyses, CU and CP were uniquely associated with three treatment outcomes each (CU—improvement in social skills and problem solving, negative behaviors in time-out; CP—time-outs per day, peer ratings, peer dislike). The implications for these findings with regard to treatment response in children with CP/ADHD with and without CU traits are explored.     

Parent Training Outcomes Among Young Children with Callous–Unemotional Conduct Problems with or at Risk for Developmental Delay

School-aged children with conduct problems and high levels of callous–unemotional (i.e., lack of empathy, guilt, and lack of caring behaviors) traits (CP + CU) tend to yield less benefit from traditional interventions than do their low-CU counterparts, particularly with respect to conduct problem (CP) outcomes. To date, little is known about treatment response among young children with CP + CU, particularly those with or at risk for developmental delay. Components of parent–child interaction therapy (PCIT), a parent training program effective at reducing CP in young children, have compelling theoretical support for addressing core deficits unique to children with CP + CU and have been used successfully with young children with developmental delay. Our first aim was to test the psychometric properties of a measure of CU traits in preschool children with and without developmental delay. Our second aim was to test whether CU traits predicted post-treatment CP after controlling for initial levels of CP. Participants were 63 families of young children (mean age = 3.87 years), with or at risk for developmental delay, who presented with elevated CP and were treated in a hospital-based outpatient clinic. Results indicated that developmentally delayed children with high levels of CU traits, but not children at risk for delay due to premature birth, showed significantly poorer CP outcomes following treatment with PCIT than did children scoring low on CU traits, even after controlling for initial CP severity. The implications of these findings with regard to treating and preventing severe disruptive behaviors among young children with CP + CU are discussed.     

Callous-Unemotional Traits Only Versus the Multidimensional Psychopathy Construct as Predictors of Various Antisocial Outcomes During Early Adolescence

The aim of this study was to compare callous-unemotional (CU) traits versus the multidimensional psychopathy construct in their ability to predict future and stable antisocial behavior. At baseline, a community sample of 996 Cypriot 12-year old adolescents (52% girls) completed measures that tap conduct problems (CP) and psychopathic traits, including CU. CP, aggression, and substance use were self-reported at 1–3 year follow-ups. Youths were assigned to six mutually exclusive groups based on their baseline levels of CP and psychopathic traits. Youth with CP scoring high on all three psychopathic traits dimensions (Psychopathic Personality?+?CP) showed the most robust and highest risk for future and stable CP, aggression, and substance use, followed by youth who were high on all three psychopathic traits dimensions but displayed no concurrent CP (Psychopathic Personality Only) and CP youth with low levels of psychopathic traits (CP Only). Youth with CP who merely manifested callous-unemotional traits (Callous-Unemotional?+?CP) were only at risk for future CP. The findings suggest that the CU traits-based approach for subtyping children with CP is less informative compared to a subtyping approach using various psychopathic traits dimensions in predicting future and stable forms of various antisocial outcomes. These findings and their consistency with prior work indicate the need for additional research to examine the various psychopathic traits dimensions rather than focusing solely on CU traits, especially for CP subtyping purposes.     

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.     

Individual, Social, and Behavioral Factors Associated with Co-Occurring Conduct Problems and Callous-Unemotional Traits

Conduct problems (CP) and callous-unemotional (CU) traits can have a long-lasting negative impact into adulthood. Importantly, among youth with CP, those high on CU traits engage in a more severe, aggressive, and persistent pattern of antisocial behavior. The current study investigates the co-occurrence between CP and CU traits among a large sample of Greek-Cypriot adolescents (N?=?1,674; 50.1 % girls). Five distinct groups were identified with Latent Profile Analysis: low risk (48.7 %), average risk (33.8 %), co-occurring high CP-high CU (5.4 %), high CP-low CU (5.2 %), and low CP-high CU (6.9 %). Although more boys were identified in the higher risk groups, boys and girls within each group were not differentiated on levels of CP or CU traits during early adolescence. Youth in the identified groups were compared on early (Mean age?=?12.12) and middle (Mean age?=?14.02) adolescence individual and contextual factors. Youth with high CP-high CU were at higher risk for behavioral (bullying and substance use), individual (inattention, impulsivity, narcissism), and contextual (low family-support) problems compared to youth in the high CP-low CU and low CP-high CU groups, providing evidence that the combination of CP and CU traits might constitute a pathological group. These findings demonstrate the usefulness of sub-typing CP based on CU traits for the forthcoming fifth edition of the Diagnostic and Statistical Manual. Additional novel findings suggested that adolescents scoring high on CP, irrespective of CU, were not differentiated on hyperactivity, victimization, and anxiety/depression, and adolescents scoring high on CU traits, with or without CP, reported similar low levels of self-esteem and peer and family social-support.     

Effects of Intensive Behavioral Treatment for Children With Varying Levels of Conduct Problems and Callous-Unemotional Traits

The purpose of this study was to examine whether callous–unemotional (CU) traits moderated the effects of intensive behavior therapy in elementary school-age children with varying levels of conduct problems (CP). Both treatment response (magnitude of change between pre- and posttreatment) and treatment outcomes (likelihood of normalization from treatment) were examined. Participants were 67 children (n = 49 boys, M_age = 9.6 years) with varying levels of CP and CU who participated in an intensive 8-week summer treatment program (STP) in which behavior therapy was delivered to children in recreational and classroom settings and to parents via weekly parent training sessions. Effects of treatment were measured using parent and teacher ratings of oppositional defiant disorder (ODD), conduct disorder (CD), callous behavior, and impairment. Results showed that CU moderated treatment effects for CD and callous behavior but not ODD or impairment. The moderating effects showed some evidence that participants with high CP and high CU before treatment had better treatment responses (larger change between pre- and posttreatment) but worse treatment outcomes (lower likelihood of normalization after treatment). These results suggest that intensive treatment, such as the STP, may be necessary but not sufficient for children with CP and CU traits.     

Trajectories of Peer-Nominated Aggression: Risk Status,Predictors and Outcomes

Developmental trajectories of peer-nominated aggression, risk factors at baseline, and outcomes were studied. Peer nominations of aggression were obtained annually from grades 1 to 3. Three developmental trajectories were identified: an early-onset/increasers trajectory with high levels of peer-nominated aggression at elementary school entry and increasing levels throughout follow-up; a moderate-persistent trajectory of aggression in which children were characterized by moderate levels of physical aggression at baseline; and a third trajectory with stable low levels of aggression. Children following the early-onset/increasers trajectory showed physical forms of aggression at baseline. Male gender and comorbid attention deficit/hyperactivity problems, oppositional defiant problems and poor prosocial behavior plus negative life events predicted which children would follow the early-onset/increasers trajectory of aggression. The outcomes associated with the early-onset/increaser children suggest high risk for chronically high levels of aggressive behavior.     

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.     

Emotional true and false memories in children with callous-unemotional traits

Several studies have found that children with callous-unemotional (CU) traits have a deficit in processing emotionally negative material. The present study examined whether this deficit also affects emotional memory. Twenty-two children with low CU traits and 24 children with high CU traits between 8 and 12 years of age were selected from a community sample and presented with neutral and negative emotional words, using the Deese–Roediger–McDermott paradigm. On true recall, there was no difference between the groups. Both groups had higher true recall rates for the neutral word lists than for the negative lists. However, on false recall, although there were no group differences for neutral word lists, the high CU group recalled significantly fewer critical lures on the negative word lists than the low CU group. Furthermore, the high CU group had significantly less false recall on the negative word lists compared to the neutral word lists, while the low CU group showed no difference in false recall between the word lists. These results indicate that children with high CU traits have no deficiencies in true memory performance, yet are less susceptible to developing false memories concerning emotionally negative material.     

Parenting Practices and Prospective Levels of Hyperactivity/Inattention Across Early- and Middle-Childhood

This study examined specific parenting practices as predictors of prospective levels of children’s hyperactivity/inattention across early- and middle-childhood. Participants were a mixed-sex community cohort (N?=?976; 52 % boys) aged 4–10 years (M?=?6.5, SD?=?1.3). Measures of parenting practices, hyperactivity/inattention, conduct problems, and maternal education were collected at baseline, and hyperactivity/inattention re-assessed at 12-month follow-up. Analyses examined predictors of 12-month hyperactivity/inattention while controlling for levels at baseline. High levels of parental involvement were associated with reduced levels of hyperactivity/inattention, but only across early childhood. Conversely, increases in child age were associated with increased levels of hyperactivity/inattention across middle-childhood, but only among children exposed to high levels of inconsistent discipline. Inconsistent discipline and parental involvement appear to be uniquely associated with prospective hyperactivity/inattention across childhood, independent of associated conduct problems. Our results further suggest some developmental specificity with regard to the effects of these distinct dimensions of parenting on hyperactivity/inattention at different points in childhood.     

Callous-unemotional traits and conduct problems in the prediction of conduct problem severity,aggression, and self-report of delinquency

The role of callous-unemotional (CU) traits and conduct problems in predicting conduct problem severity, severity and type of aggression, and self-reported delinquency at a 1-year follow-up was investigated in a sample of 98 children (mean age 12.43; SD = 1.72) recruited from a community-wide screening. Children with both CU traits and conduct problems had a greater number and variety of conduct problems at follow-up than children who at the screening had high levels of conduct problems alone. However, this poorer outcome for children with CU traits could largely be accounted for by differences in initial level of conduct problem severity. Children with CU traits and conduct problems were also at risk for showing higher levels of aggression, especially proactive aggression, and self-reported delinquency. Importantly, these outcomes could not be solely explained by initial level of conduct problem severity. Finally, CU traits predicted self-reported delinquency in some children who did not initially show high levels of conduct problems and this predictive relationship seemed to be strongest for girls in the sample who were high on CU traits but who did not show significant conduct problems.     

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.     

The importance of callous-unemotional traits for extending the concept of psychopathy to children

This study focused on the use of callous-unemotional (CU) traits to identify a subgroup of children with both attention deficit/hyperactivity disorder (ADHD) and a conduct problem diagnosis (oppositional defiant disorder [ODD] or conduct disorder [CD] who show characteristics similar to adults with psychopathy. In a clinic-referred sample of children aged 6 to 13 years (N = 154), those with diagnoses of both ADHD and ODD/CD were divided on the basis of teacher ratings of CU traits. Children high on these traits showed features typically associated with psychopathy, such as a lack of fearfulness and a reward-dominant response style. Furthermore, children with CU traits seemed less distressed by their behavior problems. These findings are consistent with research on adults showing that impulsivity and antisocial behavior alone are insufficient to document persons who fit the construct of psychopathy.     

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.     

Emotional memory for central and peripheral details in children with callous-unemotional traits

A limited number of studies have shown that adults and adolescents with psychopathic traits suffer from emotional memory impairment. The present study examined whether this finding could be replicated in a sample of children between 8 and 12?years of age with callous-unemotional (CU) traits. Children with high CU traits (n?=?24) were compared with children with low CU traits (n?=?18) with regard to performance on a peripheral memory recognition test that examined memory for central and peripheral components of neutral and negative pictures. Results showed that overall recognition rates did not differ between the high- and low-CU groups. For negative pictures, both groups demonstrated better recognition of the central component at the expense of the peripheral component, while for neutral pictures, the peripheral component was better recognized than the central component. This study is the first to demonstrate that children with high CU traits do not suffer from an impaired emotional memory. Copyright ? 2012 John Wiley & Sons, Ltd.     

Links Between Contexts and Middle to Late Childhood Social‐Emotional Development

Guided by the social‐emotional learning (SEL) framework, we studied developmental trajectory patterns of five key competency outcomes spanning middle through late childhood: altruism, empathy, self‐efficacy, aggression, and hyperactivity. We then assessed their links to middle childhood home, parental, and community contexts. Data from the Institute of Education Sciences’ Social and Character Development Program, which comprised nearly 2,400 elementary school students who were followed from Grades 3 through 5, were analyzed using growth mixture modeling. Three trajectory groups emerged for each outcome, which were linked to childhood contexts. Positive parenting was associated with a lower likelihood of following a negative empathy trajectory among children. Neighborhood intergenerational closure promoted a stable self‐efficacy trajectory. Residing in a high‐risk community was linked to increasing normative beliefs about aggression. These findings suggest an important role of contexts in influencing childhood social‐emotional development in the later elementary school years.     

Callous–Unemotional Traits in Predicting the Severity and Stability of Conduct Problems and Delinquency

The current study tests whether the presence of callous–unemotional (CU) traits designates a group of children with conduct problems who show an especially severe and chronic pattern of conduct problems and delinquency. Ninety-eight children who were selected from a large community screening of school children in grades 3, 4, 6 and 7 were followed across four yearly assessments. Children with conduct problems who also showed CU traits exhibited the highest rates of conduct problems, self-reported delinquency, and police contacts across the four years of the study. In fact, this group accounted for at least half of all of the police contacts reported in the sample across the last three waves of data collection. In contrast, children with conduct problems who did not show CU traits continued to show higher rates of conduct problems across the follow-up assessments compared to non-conduct problem children. However, they did not show higher rates of self-reported delinquency than non-conduct problem children. In fact, the second highest rate of self-reported delinquency in the sample was found for the group of children who were high on CU traits but without conduct problems at the start of the study.     

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.