Treatment Outcomes of Children with Primary Versus Secondary Callous-Unemotional Traits

Primary and Secondary Callous-Unemotional Childhood Variants in a Korean Community Sample

Despite the growing support for the multiple developmental pathways to phenotypic callous-unemotional (CU) traits (i.e., primary, and secondary CU variants), there remains limited research on childhood manifestations of CU variants in non-Western, community samples. Using a latent profile analysis with data sourced from the longitudinal, nationwide Korean sample (N = 1597, 48.7% girls), we discerned heterogeneous groups of children, based on externalizing problems, CU traits, and emotional reactivity level. The optimal five-profile solution identified distinct subgroups: low-risk, primary CU (characterized by low emotional reactivity and externalizing problem), reactive (low CU/moderate emotion reactivity and externalizing problem), and two secondary CU groups (i.e., secondary-high CU and secondary-moderate CU; both high in emotional reactivity and externalizing problems). The two secondary CU variants demonstrated differences from the primary CU variants, in that both are high in preschool externalizing problems (age 6) and school-age conduct problems (age 11). However, the secondary-moderate CU group displayed greater levels of anxiety at age 11 compared to secondary-high CU, indicating divergent developmental trajectories of secondary CU variants. These findings expand our understanding of CU variants among Korean preschoolers and highlight the role of emotional reactivity in distinguishing such subtypes and identifying their developmental outcomes across time.

Dimensions of Parenting and Children's Conduct Problems: The Importance of Considering Children's Callous-Unemotional Traits

Research has clearly indicated that the development of serious behavioral problems in children and adolescents is influenced by parenting. However, recent research has refined the role of parenting by showing the importance of distinguishing between different types of parenting and in considering the role of callous-unemotional traits (CU traits) and conduct problems (CP) of the children. In the current study, we advance this research by distinguishing between emotional (e.g., parental warmth; parental hostility) and behavioral (e.g., use of positive reinforcement; inconsistent discipline/harsh discipline) aspects of parenting and by considering the way parents respond to children's emotions (i.e., coaching and dismissing). The sample consisted of 136 mothers (M = 38.09 years, SD = 4.51 years, 45.41% high school degree) with a child (age range 3-5 years) enrolled in kindergarten in central Italy. Multiple regression analyses indicated that, after controlling for level of CP, use of positive reinforcement (β = -0.31, p < 0.001) and warm feelings (β = -0.22, p < 0.05), remained associated with CU traits and punitive parenting was no longer significant. Consistent with predictions, use of positive reinforcement was no longer associated with conduct problems when controlling for CU traits and the positive associations with punitive parenting (β = 0.24, p < 0.05) and negativity (β = 0.36, p < 0.001) remained significant. These findings support the need for continued research that considers both the emotional and behavioral aspects of parenting and disentangles their associations with conduct problems and CU traits. Such research could not only advance causal theories for children with conduct problems but also help to guide more effective treatments, especially for those with elevated CU traits who often leave treatment with significant conduct problems remaining.

The amygdala volume moderates the relationship between childhood maltreatment and callous-unemotional traits in adolescents with conduct disorder

CU traits, characterized by shallow affect, lack of fear, and absence of remorse, have been moderately associated with childhood maltreatment in a recent meta-analysis. However, the potential impact of brain structures remains undetermined. This paper examines the relationship between callous-unemotional (CU) traits, childhood maltreatment, and amygdala volumes. In this study, we used a region-of-interest (ROI) analysis to explore the interaction between the volumes of the amygdala, childhood maltreatment, and the manifestation of CU traits in adolescents diagnosed with conduct disorder (CD, N = 67), along with a comparison group of healthy-control youths (HCs, N = 89). The ROI analysis revealed no significant group differences in the bilateral amygdalar volumes. Significant positive correlation was discovered between all forms of child maltreatment (except for physical neglect) and CU traits across subjects. But the interaction of physical abuse and amygdala volumes was only significant within CD patients. Notably, a sensitivity analysis suggested that gender significantly influences these findings. These results contribute critical insights into the etiology of CU traits, emphasizing the need for customized clinical assessment tools and intervention strategies.

Primary and Secondary Variants of Callous-Unemotional Traits in Children with Conduct Problems: A Longitudinal Follow-up During Adolescence

Recent empirical work has suggested that youths with conduct problems and presenting high levels of callous-unemotional (CU) traits can be divided in two variants (i.e., primary, secondary) presenting specific characteristics and needs, but studies examining outcomes associated longitudinally with variants memberships remain scarce. Building on a previous investigation in which we identified variants of CU traits among children with conduct problems, we examined differences between groups on a wide range of behavioral/psychological, relational/social, and educational outcomes assessed during adolescence (n = 309, mean age = 17.4, SD = 0.96). When compared to those from the primary variant, youths from the secondary variant reported higher levels of conduct, opposition, attention deficit/hyperactivity and anxiety problems, had lower teacher-reported academic performance, experienced more conflictual relationships with their teachers, and were at higher risk of being victimized by their intimate partner. These results shed light on the specific clinical characteristics of children from the secondary variant that are likely to persist until adolescence. Providing these children with intensive preventive interventions targeting these long-term consequences could be particularly beneficial.

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.