Stability Subtypes of Callous-Unemotional Traits and Conduct Disorder Symptoms and Their Correlates

Different whole-brain functional connectivity correlates of reactive-proactive aggression and callous-unemotional traits in children and adolescents with disruptive behaviors

BACKGROUND

Disruptive behavior in children and adolescents can manifest as reactive aggression and proactive aggression and is modulated by callous-unemotional traits and other comorbidities. Neural correlates of these aggression dimensions or subtypes and comorbid symptoms remain largely unknown. This multi-center study investigated the relationship between resting state functional connectivity (rsFC) and aggression subtypes considering comorbidities.

METHODS

The large sample of children and adolescents aged 8-18 years (n = 207; mean age = 13.30±2.60 years, 150 males) included 118 cases with disruptive behavior (80 with Oppositional Defiant Disorder and/or Conduct Disorder) and 89 controls. Attention-deficit/hyperactivity disorder (ADHD) and anxiety symptom scores were analyzed as covariates when assessing group differences and dimensional aggression effects on hypothesis-free global and local voxel-to-voxel whole-brain rsFC based on functional magnetic resonance imaging at 3 Tesla.

RESULTS

Compared to controls, the cases demonstrated altered rsFC in frontal areas, when anxiety but not ADHD symptoms were controlled for. For cases, reactive and proactive aggression scores were related to global and local rsFC in the central gyrus and precuneus, regions linked to aggression-related impairments. Callous-unemotional trait severity was correlated with ICC in the inferior and middle temporal regions implicated in empathy, emotion, and reward processing. Most observed aggression subtype-specific patterns could only be identified when ADHD and anxiety were controlled for.

CONCLUSIONS

This study clarifies that hypothesis-free brain connectivity measures can disentangle distinct though overlapping dimensions of aggression in youths. Moreover, our results highlight the importance of considering comorbid symptoms to detect aggression-related rsFC alterations in youths.

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.

Primary and Secondary Psychopathic Traits: Investigating the Role of Attachment and Experiences of Shame

Primary and secondary psychopathic traits have been documented in the general population and previous research has shown their link to adult insecure attachment and shame. However, there has been a gap in the literature examining the specific role of attachment avoidance and anxiety, and experiences of shame in the expression of these psychopathic traits. This study aimed to explore the associations between the attachment dimensions of anxiety and avoidance, in addition to characterological, behavioral and body shame with primary and secondary psychopathic traits. A non-clinical sample of 293 adults (M age= 30.77, SD = 12.64; 34% males) was recruited and completed an online battery of questionnaires. Hierarchical regression analyses indicated that demographic variables (age and gender) explained the largest variance for primary psychopathic traits, while the attachment dimensions (anxiety and avoidance) explaining the largest variance for secondary psychopathic traits. Characterological shame had a direct and indirect effect on both primary and secondary psychopathic traits. The findings highlight the need to examine psychopathic traits in community samples as a multidimensional construct, with a particular focus on also assessing attachment dimensions and shame subtypes.

Callous-unemotional traits and anxiety in adolescents: a latent profile analysis to identify different types of antisocial behavior in a high-risk community sample

OBJECTIVE

Callous-unemotional (CU) traits are associated with a more severe and chronic trajectory of antisocial behavior. The present study aimed to identify different classes of CU and anxiety and to compare these classes on overt and covert antisocial behavior and several clinical correlates.

METHOD

In a prospective high-risk cohort of adolescents (N = 679; mean age = 14.77, SD = 0.81), latent profile analysis was conducted using CU traits and anxiety symptoms as indicators, and multi-informant aggressive and rule breaking behavior as distal outcomes. Post-hoc analyses with binary logistic regression and a series of ANCOVA were performed on identified classes assessing violent aggression, property offending, and clinical correlates.

RESULTS

Three classes were found, a reference group (low CU, low anxiety; N = 500), a high CU-low anxiety group (N = 98), and an intermediate CU-high anxious group (N = 81). The high CU-low anxiety group scored highest on property offenses, while the intermediate CU-high anxious group scored highest on aggressive behavior. The intermediate CU-high anxious group scored highest on psychotic experiences, while the high CU group scored highest on internet gaming addiction problems and bullying victimization.

CONCLUSION

These findings provide further evidence for diverse variants of CU traits in a high-risk community sample. Future prospective studies should point out whether and to what extent adolescents with CU traits with and without anxiety develop criminal careers and psychiatric disorders in adulthood.

Review of Neuropsychological and Electrophysiological Correlates of Callous-unemotional Traits in Children: Implications for EEG Neurofeedback Intervention

Conduct disorder is a significant psychiatric disorder of childhood and adolescence. The Diagnostic and Statistical Manual of Mental Disorders, fifth version (DSM-5), added the limited prosocial specifier to identify those individuals who exhibit a more severe pattern of behavior characterized by a callous and unemotional (CU) interpersonal style across multiple settings and relationships. This review has attempted to summarize the relevant research focusing on the significance of CU interpersonal style in the development of psychopathy. The primary focus was on the electrophysiological and neuropsychological correlates of CU traits and their implication on the treatment protocol using neurofeedback training for children with such traits. The source of the literature search was PubMed, which majorly uses the MEDLINE database. The keywords used included CU traits, conduct disorder, child psychopathy, empathy, electrophysiology, criminal behavior, neuropsychology, neurofeedback training, and so on. Studies from the last 15 years were considered for the review. This review revealed that children with conduct disorder and high-CU traits with a combination of reactive and proactive aggression are more likely to develop psychopathy. Evidence suggests that these children have distinct forms of electrophysiological and neuropsychological correlates. However, research in this area is still not conclusive as they yield variation in findings. Studies on the efficacy of neurofeedback training on reducing symptoms such as impulsivity, hostility, and psychopathy indicate that neurofeedback training can be a promising treatment alternative for children with severe conduct disorder.

Bidirectional Effects Between Callous-Unemotional Traits and Student-Teacher Relationship Quality Among Middle School Students

The present study investigated the bidirectional effects between callous-unemotional (i.e., CU) traits, student-teacher relationship quality, and bonds with school. A sample of 301 middle school students (156 girls; M age = 12.96 years, SD = 0.94) completed the Inventory of Callous-Unemotional Traits and the Student-Teacher Relationship Questionnaire, along with measures of both externalizing and internalizing problems, both in the first and second part of the school year (i.e., a time frame of 6 months). They also completed a peer-nominated measure of social preference within their peer group at the beginning of the school year. Results from a cross-lagged panel model suggested that, controlling for measures of both externalizing and internalizing problems, levels of affiliation with teachers were negatively related to levels of CU traits in students with low levels of social preference among peers. Moreover, a synergistic effect of high levels of both bonds with school and social preference emerged in predicting lower levels of CU traits. Similar results emerged with regard to externalizing problems, over and above the role of CU traits and internalizing problems. No effects of CU traits predicting student-teacher relationship quality emerged. Overall, the findings highlighted the teachers' role as emotion socializers and role models for the students who can promote students' emotional and relational prosperity over the development of maladaptive outcomes, including CU traits. They also stressed the importance of considering multiple environmental determinants in examining the pathways to CU traits, suggesting the need to integrate and expand previous research on parenting.

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.

Adolescents' Popularity-Motivated Aggression and Prosocial Behaviors: The Roles of Callous-Unemotional Traits and Social Status Insecurity

As competition over peer status becomes intense during adolescence, some adolescents develop insecure feelings regarding their social standing among their peers (i.e., social status insecurity). These adolescents sometimes use aggression to defend or promote their status. The aim of this study was to examine the relationships among social status insecurity, callous-unemotional (CU) traits, and popularity-motivated aggression and prosocial behaviors among adolescents, while controlling for gender. Another purpose was to examine the potential moderating role of CU traits in these relationships. Participants were 1,047 (49.2% girls; M age = 12.44 years; age range from 11 to 14 years) in the 7th or 8th grades from a large Midwestern city. They completed questionnaires on social status insecurity, CU traits, and popularity-motivated relational aggression, physical aggression, cyberaggression, and prosocial behaviors. A structural regression model was conducted, with gender as a covariate. The model had adequate fit. Social status insecurity was associated positively with callousness, unemotional, and popularity-motivated aggression and related negatively to popularity-motivated prosocial behaviors. High social status insecurity was related to greater popularity-motivated aggression when adolescents had high callousness traits. The findings have implications for understanding the individual characteristics associated with social status insecurity.

Is Callous Always Cold? A Critical Review of the Literature on Emotion and the Development of Callous-Unemotional Traits in Children

Low emotional responsiveness is considered a core feature of callous-unemotional (CU) traits in childhood and, in the context of antisocial behavior, a precursor of psychopathic traits in adulthood. However, recent findings suggest that CU traits are not always characterized by low emotional responsiveness and the evidence base requires review. This review asks a fundamental question- 'Is callous always cold?'-with a specific focus on emotional responsiveness and CU traits in children with conduct problems (CPs). PRISMA review protocols were followed to identify literature reporting on emotional responsiveness for children 3-18 years with CPs and varying (high and low) CU traits. Results from eligible studies were contrasted by age (children 3-11 years, adolescents 12-18 years), emotional responsive measurement type (physiological, behavioral, self-report), emotion-eliciting stimuli type (interactive activities, static imagery, film) and socio-emotional context of the stimuli (other-orientated, self-orientated, neutral). This review highlights considerable variation in results across studies: reduced emotional responsiveness was not synonymous with participants demonstrating high CU traits. A more consistent picture of reduced emotional responsiveness in participants with high CU traits was found when studies used physiological measures, when stimuli were other-orientated in socio-emotional context, and in older, adolescent samples. In conclusion, this paper advocates for a more nuanced understanding of the relationship between high CU traits and the specific factors involved in emotional responsiveness, ultimately suggesting that callous is not always cold. Given that emotional responsiveness is central to theories of moral development, these findings may suggest innovative approaches to early intervention.

Understanding Chronic Aggression and Its Treatment in Children and Adolescents

PURPOSE OF REVIEW

Youth aggression is common and has a significant burden on individuals, families, and society. However, its treatment is often a challenge for clinicians. Thus, this review will examine the current understanding of youth aggression, conceptualize aggression as a symptom rather than its own disorder, and provide an overview of treatment strategies.

RECENT FINDINGS

Youth aggression is associated with complex genetic, neurobiological, and environmental risks. Prevention strategies are of the utmost importance for at-risk families and youth. Psychosocial interventions are the first line treatment. But if not fully effective, then pharmacologic interventions-including psychostimulants, alpha-2 agonists, atomoxetine, and risperidone-have shown benefits. Other medications, such as SSRIs, can be useful in certain scenarios. It is important to conceptualize youth aggression as being a trans-diagnostic symptom in psychopathology. Determining the underlying cause of aggression will help to guide treatment.

Whole-cortex mapping of common genetic influences on depression and a social deficits dimension

Social processes are associated with depression, particularly understanding and responding to others, deficits in which can manifest as callousness/unemotionality (CU). Thus, CU may reflect some of the genetic risk to depression. Further, this vulnerability likely reflects the neurological substrates of depression, presenting biomarkers to capture genetic vulnerability of depression severity. However, heritability varies within brain regions, so a high-resolution genetic perspective is needed. We developed a toolbox that maps genetic and environmental associations between brain and behavior at high resolution. We used this toolbox to estimate brain areas that are genetically associated with both depressive symptoms and CU in a sample of 258 same-sex twin pairs from the Colorado Longitudinal Twin Study (LTS). We then overlapped the two maps to generate coordinates that allow for tests of downstream effects of genes influencing our clusters. Genetic variance influencing cortical thickness in the right dorsal lateral prefrontal cortex (DLFPC) sulci and gyri, ventral posterior cingulate cortex (PCC), pre-somatic motor cortex (PreSMA), medial precuneus, left occipital-temporal junction (OTJ), parietal-temporal junction (PTJ), ventral somatosensory cortex (vSMA), and medial and lateral precuneus were genetically associated with both depression and CU. Split-half replication found support for both DLPFC clusters. Meta-analytic term search identified "theory of mind", "inhibit", and "pain" as likely functions. Gene and transcript mapping/enrichment analyses implicated calcium channels. CU reflects genetic vulnerability to depression that likely involves executive and social functioning in a distributed process across the cortex. This approach works to unify neuroimaging, neuroinformatics, and genetics to discover pathways to psychiatric vulnerability.

Methylphenidate administration promotes sociability and reduces aggression in a mouse model of callousness

RATIONALE

Deficits in empathy constitute a distinctive feature of several psychopathologies, including conduct disorder (CD). The co-occurrence of callous-unemotional (CU) traits, excess rates of aggression and violation of societal norms confers specific risk for adult psychopathy. To date, the off-label use of methylphenidate (MPH) constitutes the drug treatment of choice.

OBJECTIVES

Herein, we tested the therapeutic potential of MPH in a recently devised mouse model recapitulating the core phenotypic abnormalities of CD.

METHODS

Two subgroups of BALB/cJ male mice exhibiting opposite profiles of emotional contagion (i.e. socially transmitted adoption of another's emotional states) were investigated for reactive aggression, sociability, attention control, anxiety-related behaviours and locomotor activity, in response to MPH administration (0.0, 3.0 or 6.0 mg/kg).

RESULTS

Our data indicate that mice selected for excess callousness exhibit phenotypic abnormalities isomorphic to the symptoms of CD: stability of the low emotional contagion trait, increased aggression and reduced sociability. In accordance with our predictions, MPH reduced aggression and increased sociability in callous mice; yet, it failed to restore the low responsiveness to the emotions of a conspecific in pain, isomorphic to CU traits.

CONCLUSIONS

Although our data support the notion that MPH may contribute to the management of excess aggression in CD patients, additional studies shall identify specific treatments to target the callousness domain. The latter, unaffected by MPH in our experimental model, demands focused consideration whereby it constitutes a specifier associated with a worse prognosis.

Assessing Callous-Unemotional Traits in 6- to 18-Year-Olds: Reliability, Validity, Factor Structure, and Norms of the German Version of the Inventory of Callous-Unemotional Traits

Background: This article reports reliability, validity, and norms for the German version of the multi-informant questionnaire Inventory of Callous-Unemotional Traits (ICU). Method: The ICU was filled in by nonreferred children aged 13 to 18 years old (n = 645), parents of children aged 6 to 18 years old (n = 1,005), and their teachers (n = 955). Results: Confirmatory factor analysis resulted in a two-factor solution giving the best fit. Still none of the models showed an adequate model-fit applying the chi-square exact fit test. The internal consistency of the parent's, teacher's, and self-report version were α = .830, α = .877 and α = .769, respectively. Interrater reliability was moderate. Convergent validity with the Youth Psychopathic Traits Inventory, the externalizing scores of the Youth Self-Report/Child Behavior Checklist, and with the German oppositional Defiant Disorder/Conduct Disorder Rating Scale "FBB-SSV" were good. German norms were calculated. Conclusions: The ICU is a reliable and valid dimensional measure to describe callous-unemotional traits.

The influence of stressful life events, psychopathy, and their interaction on internalizing and externalizing psychopathology

Exposure to stressful life events increases risk for both internalizing and externalizing psychopathology, but less is known about moderators of the association between stressful life events and psychopathology. The present study examined the influence of stressful life events, psychopathy, and their interaction on internalizing and externalizing psychopathology in 3877 individuals from the community. We hypothesized that (1) exposure to stressful life events would be a transdiagnostic risk factor for psychopathology, (2) primary and secondary psychopathy would be differentially associated with internalizing psychopathology, and (3) primary psychopathy would moderate the association between stressful life events and internalizing psychopathology. Confirming existing findings, our results were consistent with the first and second hypotheses. In contrast to our third hypothesis, primary psychopathy was not associated with stressful life events in childhood, inconsistently associated with stressful life events in adolescence, and did not moderate the association between stressful life events and internalizing psychopathology. Furthermore, stressful life events across development were associated with secondary psychopathy and internalizing and externalizing psychopathology. We also found similar associations between stressful life events, psychopathy, and psychopathology in females and males. Future studies investigating the impact of stressful life events on psychopathology should include psychopathic traits and stress-reactivity.

Serial Progression from Attention-Deficit/Hyperactivity Disorder to Alcohol Use Disorder: Serial Multiple Mediated Effects of Externalizing Disorders and Depression

Objective

Externalizing disorders such as attention-deficit/hyperactivity disorder (ADHD), conduct disorder and antisocial personality disorder, as well as depression are common comorbidities in alcohol use disorder (AUD). The current study focused on the temporal relationship between the onsets of these disorders and AUD, and investigated the serial multiple mediator model of externalizing disorders (e.g., ADHD) and depression on AUD.

Methods

We analyzed the mediated effects of the Adult ADHD Self-Report Scale (ASRS), the Barratt Impulsiveness Scale motor (BIS_M) and the Beck Depression Inventory (BDI) on Korean version of the Alcohol Dependence Scale (ADS_K) using the multiple-step multiple mediation procedure regression analysis. In addition, we comparatively analyzed different clinical characteristics in relation to conduct problems.

Results

The multiple-step multiple mediation procedure found the serial multiple mediated effects of the BIS_M and the BDI on the relationship between the ASRS and the ADS_K. Also, the group with conduct problem was significantly high in ADHD symptoms, depression, anxiety, impulsivity, legal problems and alcohol-related problems, compared to the group without conduct problems.

Conclusion

To sum up, the results of this study show that ADHD symptoms in childhood could exert significant effects on the severity of AUD in adulthood, and both disorders might be mediated by the externalizing disorders characterized by the core feature of motor impulsivity, and depression serially. Thus, the treatment of preceding disorders in accordance with developmental stages is an overarching clinical component for preventing the subsequent development of AUD and for its treatment.

Trajectories of callous-unemotional traits from childhood to adolescence in referred youth with a disruptive behavior disorder who received intensive multimodal therapy in childhood

PURPOSE

Our aims were to explore the developmental trajectories of callous-unemotional (CU) traits using a growth curve analysis in Italian children with disruptive behavior disorders treated with a multimodal intervention, and to test both predictors and distal outcomes of CU traits trajectories.

PATIENTS AND METHOD

One hundred and sixty-eight children were enrolled, of whom 24 were lost in the follow-up and 144 were followed up from ages 8-9 to 14-15 years with four assessment points. Patients included 128 males (88.9%) with a mean age of 8.7 years, 96 with oppositional defiant disorder (66.7%) and 48 with conduct disorder (CD) (33.3%). The developmental trajectories of CU traits were assessed with the Inventory of Callous-Unemotional Traits (ICU).

RESULTS

Our findings revealed that CU features were likely to fit a quadratic model from childhood to adolescence. The CU traits tended to decrease during childhood, with stabilization in adolescence and a significant variability in the growth curves. Pretreatment CD and higher levels of externalizing behavioral problems were associated with higher level of CU traits at baseline, whereas positive parenting was associated with lower levels. No significant effects were found for all the other predictors (socioeconomic status, negative parenting, combined pharmacotherapy). Regarding outcomes into adolescence, both higher levels of CU traits at the baseline and a lower decrease of CU traits across time points predicted a higher risk of CD diagnosis, and higher rate of referrals to mental health services and of substance use. Furthermore, pretreatment CD and negative parenting predicted a higher risk of substance use into adolescence.

CONCLUSION

Our findings suggest that a close monitoring of CU traits in referred children with disruptive behavior disorders may help to detect the patients at higher risk of poor outcome.

Low empathy-like behaviour in male mice associates with impaired sociability, emotional memory, physiological stress reactivity and variations in neurobiological regulations

Deficits in empathy have been proposed to constitute a hallmark of several psychiatric disturbances like conduct disorder, antisocial and narcissistic personality disorders. Limited sensitivity to punishment, shallow or deficient affect and reduced physiological reactivity to environmental stressors have been often reported to co-occur with limited empathy and contribute to the onset of antisocial phenotypes. Empathy in its simplest form (i.e. emotional contagion) is addressed in preclinical models through the evaluation of the social transmission of emotional states: mice exposed to a painful stimulus display a higher response if in the presence of a familiar individual experiencing a higher degree of discomfort, than in isolation. In the present study, we investigated whether a reduction of emotional contagion can be considered a predictor of reduced sociality, sensitivity to punishment and physiological stress reactivity. To this aim, we first evaluated emotional contagion in a group of Balb/cJ mice and then discretised their values in four quartiles. The upper (i.e. Emotional Contagion Prone, ECP) and the lower (i.e. Emotional Contagion Resistant, ECR) quartiles constituted the experimental groups. Our results indicate that mice in the lower quartile are characterized by reduced sociability, impaired memory of negative events and dampened hypothalamic-pituitary-adrenocortical reactivity to external stressors. Furthermore, in the absence of changes in oxytocin receptor density, we show that these mice exhibit elevated concentrations of oxytocin and vasopressin and reduced density of BDNF receptors in behaviourally-relevant brain areas. Thus, not only do present results translate to the preclinical investigation of psychiatric disturbances, but also they can contribute to the study of emotional contagion in terms of its adaptive significance.

Dimensions of youth psychopathy differentially predict concurrent pro- and antisocial behavior

Objective:

To investigate the unique contribution of narcissism and impulsivity, in addition to callous-unemotional (CU) traits, in explaining concurrent prosocial and antisocial behavior.

Method:

Two hundred and forty-nine schoolchildren (53% female; age 9-12 years) completed the self-report Strengths and Difficulties Questionnaire (SDQ) and the Antisocial Process Screening Device (APSD). Two statistical models were tested, predicting conduct problems (CP) and prosocial behavior (PB). In the first one, CU traits and gender were entered into the equation. The second model added narcissism and impulsivity.

Results:

Gender, narcissism and impulsivity, but not CU, were statistically significant predictors of CP in the second model (F_3,226 = 45.07, p < 0.001, R² = 43.7%; betas: gender = -0.20, narcissism = 0.29, impulsivity = 0.36, CU = 0.06). PB was significantly predicted by all domains except gender (F_3,226 = 42.57, p < 0.001, R² = 42.4%; betas: gender = 0.08, narcissism = -0.16, impulsivity = -0.23, CU = -0.41).

Conclusion:

Our results confirmed that CU traits refer to a distinct manifestation of psychopathy in youth, but we also found that narcissism and impulsivity are equally important when predicting CP. Previous reports of sex differences on APSD and SDQ domains were also corroborated.