Neuroendocrine factors distinguish juvenile psychopathy variants

Callous-Unemotional Traits and Co-occurring Anxiety in Preschool and School-age Children: Investigation of Associations with Family's Socioeconomic Status and Home Chaos

While contemporary literature has traditionally viewed youth with Callous-Unemotional (CU) traits as a homogeneous group, there is a growing interest in delineating two variants of CU traits based on high or low levels of anxiety. Extensive attention has been brought in the CU traits literature to the study of relational factors such as maltreatment and parenting practices. However, very few studies have looked at other environmental contexts in which the children within these two variants evolve, such as home chaos or socioeconomic status (SES). In a community sample of children aged 4 to 9, divided into a preschool sample (N = 107; Mage = 4.95, SD = 0.62) and a school-age sample (N = 153; Mage = 7.49, SD = 1.11), the current study investigated whether anxiety moderates the associations of CU traits with SES and home chaos. Hierarchical regression analyses revealed that CU traits were positively associated with home chaos, regardless of anxiety levels. CU traits were negatively associated with SES, but this effect emerged only at high levels of anxiety. Notably, these findings were observed solely in the school-age subsample. Implications for understanding the two variants of CU traits (i.e., primary and secondary) and hypotheses regarding their developmental trajectories are discussed.

Functional Connectivity of the Nucleus Accumbens across Variants of Callous-Unemotional Traits: A Resting-State fMRI Study in Children and Adolescents

A large body of literature suggests that the primary (high callousness-unemotional traits [CU] and low anxiety) and secondary (high CU traits and anxiety) variants of psychopathy significantly differ in terms of their clinical profiles. However, little is known about their neurobiological differences. While few studies showed that variants differ in brain activity during fear processing, it remains unknown whether they also show atypical functioning in motivational and reward system. Latent Profile Analysis (LPA) was conducted on a large sample of adolescents (n = 1416) to identify variants based on their levels of callousness and anxiety. Seed-to-voxel connectivity analysis was subsequently performed on resting-state fMRI data to compare connectivity patterns of the nucleus accumbens across subgroups. LPA failed to identify the primary variant when using total score of CU traits. Using a family-wise cluster correction, groups did not differ on functional connectivity. However, at an uncorrected threshold the secondary variant showed distinct functional connectivity between the nucleus accumbens and posterior insula, lateral orbitofrontal cortex, supplementary motor area, and parietal regions. Secondary LPA analysis using only the callousness subscale successfully distinguish both variants. Group differences replicated results of deficits in functional connectivity between the nucleus accumbens and posterior insula and supplementary motor area, but additionally showed effect in the superior temporal gyrus which was specific to the primary variant. The current study supports the importance of examining the neurobiological markers across subgroups of adolescents at risk for conduct problems to precise our understanding of this heterogeneous population.

The Emotionally Sensitive Child-Adverse Parenting Experiences-Allostatic (Over)Load (ESCAPE-AL) Model for the Development of Secondary Psychopathic Traits

Understanding and treatment of antisocial behavior have improved through efforts to subtype individuals based on similar risk factors and outcomes. In particular, the presence of psychopathic traits is associated with distinct etiological factors and antisocial behavior that begins early in life, is aggressive, persistent, and less likely to normalize with traditional treatments, relative to individuals low on psychopathy or its childhood precursor, callous-unemotional (CU) traits. However, important distinctions can be made within individuals with CU/psychopathic traits according to the presence of elevated anxiety symptoms and/or adverse childhood experiences, known as secondary psychopathy/CU traits. This paper provides a broad and brief overview of theory and empirical literature supporting the existence of secondary psychopathy/CU variants as a distinct subtype of childhood antisocial behavior. It outlines the Emotionally Sensitive Child-Adverse Parenting Experiences-Allostatic (Over)Load (ESCAPE-AL) model for the developmental psychopathology of secondary psychopathic/CU traits and discusses research and theory supporting this perspective. Future research directions for testing this conceptual model and its implications for assessing and treating high-risk individuals with secondary CU/psychopathic traits are discussed.

Predictive Validity of Adolescent Callous-Unemotional Traits and Conduct Problems with Respect to Adult Outcomes: High- and Low-Risk Samples

Current understanding of the predictive validity of callous-unemotional (CU) traits is limited by (a) the focus on externalizing psychopathology and antisocial behaviors, (b) a lack of long-term prospective longitudinal data, (c) samples comprised of high-risk or low-risk individuals. We tested whether adolescent CU traits and conduct problems were associated with theoretically relevant adult outcomes 12-18 years later. Participants were drawn from two studies: higher-risk Fast Track (FT; n = 754) and lower-risk Child Development Project (CDP; n = 585). FT: conduct problems positively predicted externalizing and internalizing psychopathology and partner violence, and negatively predicted health, wellbeing, and education. Three conduct problems × CU traits interaction effects were also found. CDP: CU traits positively predicted depression and negatively predicted health and education; conduct problems positively predicted externalizing and internalizing psychopathology and substance use, and negatively predicted wellbeing. CU traits did not provide incremental predictive validity for multiple adult outcomes relative to conduct problems.

Developmental Precursors of Primary and Secondary Callous-Unemotional Traits in Youth

There is growing evidence of diverse etiological pathways to the development of callous-unemotional (CU) traits, known as primary and secondary CU variants. The purpose of the present study was to extend previous cross-sectional research and examine theoretical predictors of CU variants prospectively from childhood to adolescence. Participants included high-risk control and normative samples from the Fast Track project (N = 754, male = 58%, Black = 46%). Using structural equation modelling, primary CU traits, identified in early adolescence, were associated with higher levels of childhood emotion regulation and lower levels of prosocial behavior. Secondary CU traits were associated with lower levels of childhood emotion regulation and low parental warmth, but not prosocial behaviour. Neither CU variant was related to harsh parenting. Parental warmth moderated emotion regulation and prosocial behavior on secondary CU traits. Results were not moderated by sex. A greater understanding of theoretical developmental precursors of CU variants may better guide intervention efforts.

Primary and secondary callous-unemotional traits in adolescence are associated with distinct maladaptive and adaptive outcomes in adulthood

While phenotypically indistinguishable with respect to callousness, individuals with primary and secondary callous-unemotional (CU) traits may show different developmental outcomes. This research predominantly comprised cross-sectional studies of male participants with a focus on maladaptive correlates. Thus, the present study examined whether youth with primary and secondary CU traits identified in Grade 7 reported distinct maladaptive outcomes (internalizing, externalizing, and substance use problems; criminal offenses; and sexual and partner experiences) and adaptive outcomes (health and wellbeing, education, and employment) in adulthood at age 25. We also examined sex differences. Participants included the high-risk control and normative samples from the Fast Track project (N = 754, male = 58%, Black = 46%). Youth with secondary CU traits reported higher levels of adult internalizing and externalizing psychopathology, a greater number of sexual partners and risky sexual behavior, and a greater number of violent offenses, compared with individuals with primary CU traits and those with low CU and anxiety symptoms. Conversely, youth with primary CU traits and low symptoms had higher wellbeing and happiness scores than those with secondary CU traits. Finally, there was differentiation on outcomes between female primary and secondary CU variants and male primary and secondary CU variants.

Subgrouping children and adolescents with disruptive behaviors: symptom profiles and the role of callous-unemotional traits

Disruptive behavior during childhood and adolescence is heterogeneous and associated with several psychiatric disorders. The identification of more homogeneous subgroups might help identify different underlying pathways and tailor treatment strategies. Children and adolescents (aged 8-18) with disruptive behaviors (N = 121) and healthy controls (N = 100) were included in a European multi-center cognition and brain imaging study. They were assessed via a battery of standardized semi-structured interviews and questionnaires. K-means cluster-model analysis was carried out to identify subgroups within the group with disruptive behaviors, based on clinical symptom profiles, callous-unemotional (CU) traits, and proactive and reactive aggression. The resulting subgroups were then compared to healthy controls with regard to these clinical variables. Three distinct subgroups were found within the group with disruptive behaviors. The High CU Traits subgroup presented elevated scores for CU traits, proactive aggression and conduct disorder (CD) symptoms, as well as a higher proportion of comorbidities (CD + oppositional defiant disorder + attention deficit hyperactivity disorder (ADHD). The ADHD and Affective Dysregulation subgroup showed elevated scores for internalizing and ADHD symptoms, as well as a higher proportion of females. The Low Severity subgroup had relatively low levels of psychopathology and aggressive behavior compared to the other two subgroups. The High CU Traits subgroup displayed more antisocial behaviors than the Low Severity subgroup, but did not differ when compared to the ADHD and Affective Dysregulation subgroup. All three subgroups differed significantly from the healthy controls in all the variables analyzed. The present study extends previous findings on subgrouping children and adolescents with disruptive behaviors using a multidimensional approach and describes levels of anxiety, affective problems, ADHD, proactive aggression and CU traits as key factors that differentiate conclusively between subgroups.

Examining the potential link between child maltreatment and callous-unemotional traits in children and adolescents: A multilevel analysis

BACKGROUND

There is a great deal of research indicating that callous-unemotional traits in childhood are among the strongest predictors of adult psychopathy and psychopathic traits. As a result, there has been a recent surge of studies examining potential risk factors that may be related to the development of callous-unemotional traits.

OBJECTIVE

The current study sought to extend prior research examining potential risk factors for the development of callous-unemotional traits by estimating the extent to which child maltreatment related to callous-unemotional traits in children and adolescents.

PARTICIPANTS

To do so, the study uses a longitudinal sample of 4579 male and female youths drawn from the National Survey of Child and Adolescent Well-Being (NSCAW I) across four waves of data. Data collection ran from November 1999 to December 2006.

METHODS

A series of multilevel random-effects models were estimated in order to examine the association between child maltreatment and callous-unemotional traits.

RESULTS

The results of the analyses revealed a significant association between child maltreatment and callous-unemotional traits across all the models. Additionally, our models demonstrated that the association between child maltreatment and callous-unemotional traits may be dependent upon the biological sex of the individual with child maltreatment having a stronger effect on males than females (β = 0.15*).

CONCLUSIONS

Overall, our analyses lend support to prior research examining child maltreatment as a risk factor for the development of callous-unemotional traits in youth. We conclude by discussing the implications of our study and considerations for future research.

Salivary cortisol patterns in psychopathic and non-psychopathic offenders

Previous research has described diverse biological correlates of the psychopathic personality. Efforts to understand the underpinnings of low fear responses in psychopathic individuals have drawn attention to the possible role of abnormalities in hypothalamic-pituitary-adrenal (HPA) axis function, but studies to date have been largely limited to youth or to adult community samples. The current study therefore examined morning basal cortisol levels and responses to a psychosocial stress task in a forensic clinical sample of psychopathic offenders (n = 14), non-psychopathic offenders (n = 22), and non-offender controls (n = 14). Morning cortisol levels were similar in all three groups. Throughout the stress task, psychopathic offenders showed significantly lower cortisol than controls; non-psychopathic offenders showed a similar but non-significant trend towards lower cortisol. The three groups did not differ, however, in cortisol response slopes. Implications of these findings are discussed in the framework of current theories about biological mechanisms underlying psychopathic personality.

A Systematic Review of Primary and Secondary Callous-Unemotional Traits and Psychopathy Variants in Youth

Two variants of callous-unemotional (CU) traits and psychopathy have been proposed, referred to as primary and secondary. Whereas primary variants are thought to be underpinned by insufficient arousal to emotional cues, secondary variants are thought to develop as a coping mechanism in response to trauma exposure. Compared with adult samples, research on primary and secondary variants in children and adolescents under the age of 18 has only emerged in the past decade, and there is ongoing debate with regards to the identification, defining characteristics, and distinct correlates of these variants. The present systematic review synthesizes the current literature on primary and secondary variants in relation to: (1) constructs used to distinguish and define primary and secondary variants; (2) study population characteristics; (3) data analytic techniques to differentiate variants; and (4) differential associations with theoretically relevant indices related to emotional processing, maltreatment, biomarkers, and behavioral outcomes (e.g., substance use, aggression). This is the first systematic review to examine the growing literature on primary and secondary CU and psychopathy variants among youth. Findings support the distinction between youth with primary versus secondary variants and demonstrate that this distinction is related to unique clinical correlates. Recommendations are made for future research in the field.

Relation between basal cortisol and reactivity cortisol with externalizing problems: A systematic review✰

Delinquent behavior describes one of the most severe forms of antisocial and aggressive behavior, causing the highest mental health and public expenditures of problematic behavior in adolescence. Literature suggests that different concentrations of cortisol may serve as a biological marker for a severe antisocial subgroup of adolescents, although from the environmental risk factors that play a role in the development of severe delinquent and aggressive behavior, other neurobiological factors may be important. This review aims to analyze the association of cortisol levels with the development of delinquent behavior. Studies related to the topic were obtained from multiple databases, through rigorous exclusion and inclusion criteria. Only papers with empirical and quantitative methodologies from scientific and academic publications were included. Aims, methodological aspects (sample and instruments), and main conclusions were extracted from each study. Overall, the data suggest that regardless of the literature relating low cortisol levels to conduct problems and antisocial behavior, the lack of consensus in the examined studies demonstrates that more studies are needed to reveal the role of biosocial mechanisms in this hormonal-behavior link, and how these mechanisms are involved in establishing and maintaining delinquent behavior.

Child maltreatment and depression: A meta-analysis of studies using the Childhood Trauma Questionnaire

BACKGROUND

Researchers have documented that child maltreatment is associated with adverse long-term consequences for mental health, including increased risk for depression. Attempts to conduct meta-analyses of the association between different forms of child maltreatment and depressive symptomatology in adulthood, however, have been limited by the wide range of definitions of child maltreatment in the literature.

OBJECTIVE

We sought to meta-analyze a single, widely-used dimensional measure of child maltreatment, the Childhood Trauma Questionnaire, with respect to depression diagnosis and symptom scores.

PARTICIPANTS AND SETTING

192 unique samples consisting of 68,830 individuals.

METHODS

We explored the association between total scores and scores from specific forms of child maltreatment (i.e., emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect) and depression using a random-effects meta-analysis.

RESULTS

We found that higher child maltreatment scores were associated with a diagnosis of depression (g = 1.07; 95 % CI, 0.95-1.19) and with higher depression symptom scores (Z = .35; 95 % CI, .32-.38). Moreover, although each type of child maltreatment was positively associated with depression diagnosis and scores, there was variability in the size of the effects, with emotional abuse and emotional neglect demonstrating the strongest associations.

CONCLUSIONS

These analyses provide important evidence of the link between child maltreatment and depression, and highlight the particularly larger association with emotional maltreatment in childhood.

Minimally-invasive methods for examining biological changes in response to chronic stress: A scoping review

BACKGROUND

Nurse researchers are increasingly interested in incorporating biological indicators related to chronic stress, or repeated or constant exposure to psychological stressors. Minimally invasive collection methods may improve access to vulnerable populations.

OBJECTIVE

To map biological indicators measured through minimally invasive methods investigating biological changes in response to chronic stress.

DESIGN, DATA SOURCES, AND METHODS

The paper seeks to answer two questions: What are the characteristics of the minimally-invasive methods used to measure the biological correlates of chronic stress? What are the limitations regarding the use of the minimally-invasive methods and/or biological indicators identified above? Authors completed a scoping review following guidelines from the Joanna Briggs Institute Manual and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews. A literature search was completed in PubMed, PsycINFO, and Scopus. 2518 articles were screened and 145 studies were included. Data were extracted using a standardized extraction tool, compiled, and coded.

RESULTS

Studies included minimally-invasive methods to measure the hypothalamic-adrenal-pituitary axis (N = 173), immune and inflammatory markers (N = 118), and adult neurogenesis (N = 6). Cortisol was most frequently measured (N = 136), usually in saliva (N = 86). Studies included a variety of limitations for the methods and indicators, including concerns about timing and accuracy of collection, frequency of sampling, and controlling for acute stressors.

CONCLUSIONS

Nurse researchers have access to many minimally-invasive methods to measure altered biological processes related to chronic stress. A gap identified by this review is the paucity of minimally-invasive methods for investigating neurogenesis; the measurement of brain derived neurotrophic factor in plasma is a distal proxy and further research is needed to test the response of peripheral levels to psychosocial stress interventions. Additionally, while this scoping review allows nurse researchers to consider possible biological indicators to include in their research, future research is still needed on some of the basic premises of stress research, including agreement on the conceptualization of chronic stress.

Female primary and secondary psychopathic variants show distinct endocrine and psychophysiological profiles

Research with predominantly male samples supports primary and secondary developmental pathways to psychopathy that are phenotypically indistinguishable on aggressive and antisocial behavior. The aim of this study was to examine whether female variants of psychopathy show divergent endocrine (i.e., cortisol, dehydroepiandrosterone [DHEA], testosterone, and their ratios) and psychophysiological (i.e., heart rate variability [HRV]) reactivity to social provocation. We also tested whether variants differed on reactive aggression when performing a competitive reaction time task against the fictitious participant who previously insulted them. Latent profile analyses on 101 undergraduate women oversampled for high psychopathic traits identified a high-anxious, maltreated secondary variant (n=64) and a low-anxious primary variant (n=37). Although variants did not differ on aggression, secondary variants showed higher cortisol, testosterone, cortisol-to-DHEA ratios, and HRV following social provocation relative to primary variants. Findings suggest that the neurobiological mechanisms underpinning aggression in psychopathy may differ between women on primary versus secondary developmental pathways.

Towards understanding atypical social affiliation in psychopathy

One distinctive feature of individuals with psychopathy is their reduced motivation and capacity to develop authentic social relationships, which are founded on an enjoyment of prosocial interactions or concern for others. Surprisingly, potential neurocognitive vulnerabilities contributing to atypical social affiliation, and lack of prosocial behaviours in psychopathy, have yet to be systematically investigated. Research efforts have largely focused on how individuals with psychopathy process negative emotions, and how this might affect their capacity to feel guilt or empathise with others' distress. Here, we propose a framework for understanding the development of atypical social affiliation and attachment in psychopathy, and outline several key processes and neural systems speculated to underpin them. We then describe present neurocognitive findings that suggest that these processes and neural systems are compromised in individuals with, or at risk of developing, psychopathy. Finally, we consider several research directions that would help with the understanding of the origin and development of social affiliation in individuals with psychopathy. This work has the potential to inform and enhance prevention and treatment strategies.

Daily oxytocin patterns in relation to psychopathy and childhood trauma in residential youth

Inconsistent findings have been found on the relation between oxytocin levels and psychopathy or callous-unemotional (CU) traits in humans, potentially because the role of trauma in oxytocin secretion and the distinction between primary and secondary psychopathy have been overlooked so far. Primary psychopathy has a stronger biological background, whereas secondary psychopathy mainly develops due to environmental adversity, such as childhood trauma. This study investigated the interaction effects of CU traits and childhood trauma on daily salivary oxytocin levels in 57 males living in residential youth care facilities. Participants provided six saliva samples (morning, afternoon, and evening for two consecutive days) and completed self-report questionnaires on CU traits and childhood trauma. A mean daily oxytocin and an oxytocin pattern across the day were examined. A significant interaction between CU traits and one trauma category (emotional neglect) on mean daily oxytocin was observed, demonstrating that subjects with high CU traits and low levels of emotional neglect (primary psychopathy) exhibited lower daily oxytocin secretion compared to subjects with high CU traits and high levels of emotional neglect (secondary psychopathy). There were no significant interactions with the other trauma types or in daily oxytocin patterns. Our findings provided a first insight into the potentially distinct oxytocin concentrations in primary and secondary psychopathy, suggesting that primary psychopathy might be linked to lower daily oxytocin output. Future longitudinal studies are required to unravel the developmental patterns of oxytocin secretion and determine whether lower oxytocin output might be a biomarker of primary psychopathy.

Dehydroepiandrosterone (DHEA) and its ratio to cortisol moderate associations between maltreatment and psychopathology in male juvenile offenders

This study examined whether DHEA and its ratio to cortisol moderated risk for psychopathology among incarcerated youth exposed to childhood maltreatment. Resistance to stress-related psychopathology under adversity was also examined in relation to callous-unemotional (CU) traits, a personality construct characterized by resistance to pathological anxiety and blunted reactivity to threatening stimuli. Participants were 201 ethnically heterogeneous (41.8% White, 35.3% Black, 17.2% Hispanic) adolescent boys (M age = 16.75, SD = 1.15 years) incarcerated in a juvenile detention facility in the South Eastern United States who provided four afternoon saliva samples (later assayed for DHEA and cortisol) and completed self-report questionnaires. Results indicated that childhood maltreatment was associated with greater internalizing problems at lower DHEA concentrations and at higher cortisol-to-DHEA ratios. Conversely, higher DHEA levels and lower cortisol-to-DHEA ratios were associated with greater CU traits, irrespective of maltreatment exposure. CU traits did not attenuate levels of psychopathology in maltreated youth. Findings inform biosocial models of how exposure to parental maltreatment in early life contributes to risk and resilience through mechanisms associated with adaptive environmentally sensitive biological systems and processes.

Dehydroepiandrosterone and Dehydroepiandrosterone-Sulfate and Emotional Processing

Steroid hormones are important regulators of brain development, physiological function, and behavior. Among them, dehydroepiandrosterone (DHEA) and dehydroepiandrosterone-sulfate (DHEAS) also do modulate emotional processing and may have mood enhancement effects. This chapter reviews the studies that bear relation to DHEA and DHEAS [DHEA(S)] and brain emotional processing and behavior. A brief introduction to the mechanisms of action and variations of DHEA(S) levels throughout life has also been forward in this chapter. Higher DHEA(S) levels may reduce activity in brain regions involved in the generation of negative emotions and modulate activity in regions involved in regulatory processes. At the electrophysiological level, higher DHEA-to-cortisol and DHEAS-to-DHEA ratios were related to shorter P300 latencies and shorter P300 amplitudes during the processing of negative stimuli, suggesting less interference of negative stimuli with the task and less processing of the negative information, which in turn may suggest a protective mechanism against negative information overload. Present knowledge indicates that DHEA(S) may play a role in cortical development and plasticity, protecting against negative affect and depression, and at the same time enhancing attention and overall working memory, possibly at the cost of a reduction in emotional processing, emotional memory, and social understanding.

Understanding the development of psychopathy: progress and challenges

Psychopathy is an adult condition that incurs substantial societal and individual costs. Here we review neurocognitive and genetically informative studies that shed light on how and why this condition emerges. Children cannot present with psychopathy. However, the presence of callous-unemotional (CU) traits can distinguish a group of children who are at elevated risk of psychopathy in adulthood. These children display diminished empathy and guilt and show attenuated brain activation to distress cues in others. Genetically informative studies indicate that individual differences in CU traits show moderate-to-strong heritability, but that protective environmental factors can counter heritable risk. On the basis of the extant research findings, we speculate on what might represent the priorities for research over the next decade. We also consider the clinical implications of these research findings. In particular, we consider the importance of delineating what precisely works for children with CU traits (and their parents) and the ways in which intervention and prevention programs may be optimized to improve engagement as well as clinical outcomes.

Characterising youth with callous-unemotional traits and concurrent anxiety: evidence for a high-risk clinical group

Growing evidence supports the existence of two variants of youth with high callous-unemotional (CU) traits who present with markedly different risk profiles and outcomes, with potential implications for risk assessment and treatment formulation. So far, studies have identified variants of CU youth mainly using data-driven cluster approaches based on levels of CU traits and co-occurring anxiety. Yet, the extent to which this knowledge may be translated into clinical practice is unclear. To this end, the present study employed a severity-based, cut-off approach to systematically characterise CU groups across a range of clinically informative domains, including trauma history, psychiatric symptomatology, affective functioning, attachment style and behavioural risk. Analyses were based on multi-rated data from a community sample of high-risk youths (n = 155, M = 18 years). Consistent with previous studies, we found that, whereas variants show comparable levels of antisocial behaviour, those who present with both high CU and high anxiety report more severe childhood maltreatment, psychological distress, ADHD symptomatology and behavioural risk-including substance use, suicidal ideation and unsafe sex. In addition, these youth show greater attachment insecurity and affective dysregulation, as indexed by levels of irritability and alexithymia. Together, findings indicate that (1) trauma history is a key factor that differentiates variants of CU youth high vs. low on anxiety, and (2) differences in individual functioning across variants point to the need for tailored clinical assessment tools and intervention strategies. Importantly, the present findings indicate that variants of CU youth can be meaningfully differentiated using cut-off based approaches that parallel methods used in clinical assessments.