Callous-Unemotional Traits and Disorganized Attachment: Links with Disruptive Behaviors in Toddlers

A systematic review of callous-unemotional traits and attachment in children and adolescents

METHODS

The systematic review and meta-analysis included 17 research articles from 1994 to 2022. Results were summarized by developmental periods.

RESULTS

Attachment insecurity was associated with CU traits across development (r = .17). This association was marginally stronger for high-risk samples (e.g., clinical, justice) and for continuous attachment measures versus coding schemes. From early to middle childhood, attachment disorganization was associated with CU traits (r = .17).

IMPLICATIONS

Research on attachment and CU traits in childhood is still in its infancy. Changes in attachment measures from childhood to adolescence make developmental comparisons difficult. Results suggest attachment as a potential developmental mechanism for youth with CU traits, however, the area requires more research.

Variants of Callous-unemotional traits in childhood: investigation of attachment profile and hostile attribution bias

There is increasing evidence of interest in describing two variants of CallousUnemotional (CU) traits based on high (secondary variant) or low (primary variant) levels of anxiety. However, studies are limited in childhood. The present study aimed to further the understanding of the variants, specifically in association with hostile attribution bias (HAB) and attachment. In a community sample of children aged 4 to 9 (N = 70), the study examined whether anxiety moderated the association of CU traits with HAB, secure and disorganized attachment representations. Hierarchical regression analyses revealed that CU traits were positively associated with disorganized attachment, regardless of the anxiety level. In contrast, CU traits were not associated with secure attachment. A significant interaction revealed that CU traits were positively associated with HAB only at high levels of anxiety. Implications for understanding the variants of CU traits and hypotheses regarding their developmental trajectories are discussed.

Adolescent affective psychopathic traits: the long-term outcomes of mother-infant attachment across 14 years

Affective psychopathic traits have been associated with increased violence and aggression. The scholarly interest in the pathways leading to affective psychopathic traits in adolescence has been growing. Infant attachment security may be one of the early life factors that contribute to the development of affective psychopathic traits. In this study, we test the infant attachment styles measured with the Strange Situation Procedure as a predictor of adolescent affective psychopathic traits measured in three dimensions: remorselessness, unemotionality, and callousness, among 1149 families in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (SECCYD). Propensity scores for the four attachment styles were estimated with iterative tree-based regression models. After accounting for the potential confounding effects of demographic characteristics and child temperament with the inverse probability of treatment weighting, weighted generalized linear models revealed the association between insecure/avoidant attachment style measured one year after childbirth and higher levels of remorselessness, unemotionality, and callousness at 15 years. These findings provide insights into the long-term outcomes for attachment relationships established in early life.

Childhood Experiences of Alternative Care and Callousness/Unemotionality: A Conceptual Model, Scoping Review, and Research Agenda

Individuals with experiences of alternative care (AC; i.e., out-of-home care and institutional care) are at high risk for various mental health and relational problems stemming from exposure to serious attachment disruptions, loss, and complex trauma. Yet, despite the interpersonal context of their significant adversities, surprisingly there is scant research explicitly focusing on callousness/unemotionality (e.g., lack of guilt, callous disregard for others) in this population. This paper provides the first conceptual model for, and systematic scoping review of, callousness/unemotionality in children and young people with experiences of AC. In a comprehensive search of nine databases, 22 articles involving samples of participants in AC or with histories of AC, were identified for inclusion. The pattern of findings revealed that callous-unemotional and psychopathic traits are elevated in children and young people with AC experiences, and positively associated with AC. Moreover, results showed associations between these traits and various psychosocial correlates, most consistently with externalizing and internalizing problems and attachment-related problems. Only two intervention studies were located, one of which found benefits of training and supporting foster caregivers for reducing callous-unemotional traits. These findings are discussed with respect to gaps in the literature, future research directions, and trauma-informed practice to assess and treat callousness/unemotionality in children and young people with experiences of AC.

Conception and Development of the Warmth/Affection Coding System (WACS): A Novel Hybrid Behavioral Observational Tool for Assessing Parent-to-Child Warmth

A vast body of research and theory underscores the importance of parental warmth/affection (hereby 'warmth' and 'warmth/affection' are used interchangeably) as a distinct relational process that is fundamental to core developmental processes including parent-child attachment, socialization, emotion recognition and responsivity, and empathic development. The increasing focus on parental warmth as a viable transdiagnostic and specific treatment target for Callous-Unemotional (CU) traits highlights the critical need for a reliable and valid tool for measuring this construct within clinical contexts. However, existing assessment methods have limitations in their ecological validity, clinical utility, and the comprehensiveness of their coverage of core warmth subcomponents. In response to this clinical and research need, the observational Warmth/Affection Coding System (WACS) was developed to comprehensively measure parent-to-child warmth/affection. This paper chronicles the conception and development of the WACS, which adopts a hybrid approach of utilizing both microsocial and macro-observational coding methods to capture key verbal and non-verbal subcomponents of warmth that are currently underrepresented or poorly captured by existing assessment tools. Recommendations for implementation and future directions are also discussed.

Facial reactions to emotional films in young children with conduct problems and varying levels of callous-unemotional traits

BACKGROUND

Elevated levels of callous-unemotional (CU) traits have proven useful for identifying a distinct subgroup of children whose conduct problems (CP) are early emerging, severe, persistent, and underpinned by aberrant emotional processing. The early childhood emotional experiences and expressions of CP subtypes are poorly understood, despite their importance to understanding the problematic attachments and atypical social affiliation experienced by children with elevated CU traits. The current study aimed to test for differences in facial emotional reactions to mood-inducing film clips in children with CP and varying levels of CU traits.

METHOD

We compared facial emotional reactions during a developmentally appropriate mood induction task in a mixed-sex sample of clinic-referred preschool children (Mage  = 3.64 years, SD = 0.63, 66.9% male) classified as CP with elevated levels of CU traits (CP + CU; n = 25) versus low CU traits (CP-only; n = 47), and typically developing children (TD; n = 28).

RESULTS

Relative to TD children, children with clinical CP showed less congruent and more incongruent facial emotional expressions to sad and happy film clips, controlling for child sex, age, and ethnicity.

CONCLUSIONS

Consistent with older samples, young children with CP show atypical facial emotional expressions in response to positive and negative emotional stimuli. Findings have implications for developmental models of childhood antisocial behavior and can inform the development of targeted interventions.

Association between childhood maltreatment and callous-unemotional traits in youth: A meta-analysis

Callous-unemotional (CU) traits (i.e., lack of remorse or guilt, callous lack of empathy, deficient concern for the feelings of others) in youth with conduct problems confer risk for a particularly severe and persistent form of antisocial behaviour. Previous research has linked childhood maltreatment as a potential risk factor for CU traits, both primary (i.e., genetically underpinned) and secondary (i.e., environmentally influenced) variants, but findings have been inconsistent, and the association has not yet been tested in a meta-analysis. To address this gap, we conducted a meta-analysis to assess the nature and strength of the associations between childhood maltreatment and its subtypes with CU traits and potential variants (i.e., primary and secondary CU traits). A systematic search identified 29 eligible studies including 9,894 participants (42% female) between the ages of 3 and 18 years (Mage=14.22 years, SD = 1.07). Results revealed a significant moderate positive association between childhood maltreatment and CU traits. All subtypes of maltreatment bar sexual abuse were significantly associated with CU traits. However, it was not possible to compare primary and secondary CU traits directly due to inconsistencies in how they are defined. The limitations posed by current research signal the need for clinical and operational guidelines on how to define primary and secondary CU traits. Additionally, prospective longitudinal, genetically informed research is needed to clarify if maltreatment is a causal risk factor for CU traits.

Parental attachment and emotional intelligence mediates the effect of childhood maltreatment on callous-unemotional traits among incarcerated male adolescents

This study aimed to examine the impact of childhood maltreatment on callous-unemotional (CU) traits among incarcerated male adolescents, focusing primarily on the roles of parental attachment and emotional intelligence. A total of 454 male incarcerated adolescents from two juvenile correctional facilities, ranging in age from 14 to 18 years, completed a set of questionnaires consisting of a childhood trauma questionnaire, parent-attachment scale, emotional intelligence scale, and the Inventory of CU traits. The results revealed that childhood maltreatment, parental attachment, and emotional intelligence were all correlated with CU traits. Structural equation modeling analysis and the bootstrap test indicated that parental attachment and emotional intelligence mediated, in part, the effect of childhood maltreatment on CU traits. These findings expand the outcomes of previous research and shed light on how childhood maltreatment is related to CU traits.

Multiple needs and multiple treatments. What's a clinician to do? Update on the psychosocial treatment of disruptive behaviours in childhood

PURPOSE OF REVIEW

There are a wide range of psychosocial treatment options, delivered in different modalities, for children with disruptive behaviour. However, clinicians face many challenges in ensuring the empirically supported treatments (ESTs) they select will be effective for their patient. This has prompted studies to generate knowledge on how to improve treatment outcomes for children with disruptive behaviour. This review identifies the major challenges in treatment selection as well as emerging research seeking to improve outcomes.

RECENT FINDINGS

This review emphasizes the salience of the research-practice gap associated with establishing ESTs using narrow definitions of clinical problems. Recent research is reviewed considering the complex determinants of disruptive behaviours, including parent and family factors that influence outcomes. The review subsequently outlines recent advances in research and clinical practice guidelines aiming to surmount these challenges. Key advances discussed include examining the most impactful components of ESTs, personalizing interventions by targeting core dysfunction underlying behaviour, and addressing parent factors including mental health and cultural relevance to improve outcomes.

SUMMARY

Thorough assessment of patients' needs, combined with knowledge of treatment response predictors, are recommended to determine the most suitable treatment plan. Recent advances have focused on developing and designing interventions that meet needs in a way that is flexible and tailored.

Empathy, Self-control, Callous-Unemotionality, and Delinquency: Unique and Shared Developmental Antecedents

The current investigation tested childhood developmental antecedents of adolescent empathy, self-control, callous-unemotionality, and delinquency, namely difficult temperament, positive socialization experiences, and intelligence; it also tested potential mediation effects of temperament via socialization. Data were collected as part of the National Institute of Child Health and Human Development Early Child Care and Youth Development Study, which followed N = 1364 children from birth through 15 years (51% female, 80% European American). Early positive socialization (maternal sensitivity, secure attachment, and quality home environment) and temperament variables were assessed from 1 to 36 months, intelligence at age 9, and self-control, empathy, callous-unemotionality, and delinquency at age 15. Based on structural equation modeling hypothesis tests, early positive socialization positively predicted self-control and empathy, and negatively predicted callous-unemotionality and delinquency. Intelligence uniquely and positively predicted empathy. Difficult infant temperament indirectly predicted each of the four traits through early positive socialization. Important research and practical implications are discussed.

Adult attachment and psychopathic traits: Investigating the role of gender, maternal and paternal factors

Individuals with psychopathic traits have been identified to display insecure attachment. However, it is not clear which attachment dimension contributes more to high psychopathic traits, and more specifically to callous-unemotional (CU) traits, which parental relationship is more influential and if this differs across gender. This study examined the associations of adult attachment dimensions (avoidance and anxiety) and parental factors (regard, responsibility and control) with CU traits (N = 1149) using Hierarchical Linear Regression. The relationship with both parents was assessed separately to identify their unique contribution to CU traits in males and females respectively. The avoidant attachment positively predicted while the anxiety attachment dimension negatively predicted CU traits and this was the case for both male and female participants. Interestingly, maternal regard was a negative predictor of CU traits in males only, whereas paternal responsibility arose as a positive predictor of CU traits in females only. Attachment dimensions explained the largest variance in both males and females. Findings point to the importance of attachment dimensions contributing to CU traits even in an adult sample. Parental variables were less influential on CU traits compared to attachment related variables and findings suggest that there are differences between males and females. These findings have important implications for gender differentiated attachment based interventions for individuals with CU traits.