Child psychopathic traits moderate relationships between parental affect and child aggression

The Moderating Role of Surgency, Behavioral Inhibition, Negative Emotionality and Effortful Control in the Relationship between Parenting Style and Children’s Reactive and Proactive Aggression

The principal aim of this study is to explore the moderating role of temperament in the relationship between parenting style and the reactive and proactive aggressive behavior of 8-year-old children. The participants are 279 children (154 boys and 125 girls). To measure reactive and proactive aggression, children completed the reactive and proactive questionnaire (RPQ). Child temperament and parenting styles were evaluated by both parents using the temperament in middle childhood questionnaire (TMCQ) and the parenting styles and dimensions questionnaire (PSDQ). The results revealed that boys with high surgency levels and authoritarian fathers displayed more reactive aggression, whereas behaviorally inhibited boys with mothers who scored low for authoritarian parenting displayed less reactive aggression. Finally, girls with high levels of effortful control and mothers who scored low for authoritative parenting displayed more proactive aggression. The results highlight the value of studying the moderating role of temperament in the relationship between children’s aggressive behavior and both mothers’ and fathers’ parenting styles, and underscores the importance of doing so separately for boys and girls.

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.

An antisocial alchemy: Psychopathic traits as a moderator of the different forms and functions of aggression in delinquency and conduct disorder among youth

The aim of the present study is to examine the possible role of psychopathic traits as a moderator of the aggression-antisociality/delinquency link. Our sample was composed of 567 youth (M = 15.91 years, SD = 0.99 years, age range = 14-18 years) from Portugal. Results indicated that psychopathic features significantly moderate four different forms and functions of aggression - proactive overt, proactive relational, reactive overt, and reactive relational - when predicting delinquency. However, psychopathic traits only significantly moderate proactive relational aggression when predicting Conduct Disorder. Psychopathic traits and aggression constitute an antisocial alchemy for antisocial behavior but more research is needed about moderation effects therein particularly among clinical and justice system involved samples of youth to inform behavioral interventions.

Parenting behavior and growth of child conduct problems: Moderation by callous-unemotional traits

Although positive parenting behavior is central to efficacious interventions for child conduct problems (CP), studies of youth CP have focused mostly on negative parenting behavior. That is, few studies have examined dimensions of positive parenting behavior (e.g., positive reinforcement, involvement) as independent predictors of CP and even fewer have investigated their potential moderation by callous-unemotional (CU) traits. A sample of 184 6-9 year-old children with and without attention-deficit/hyperactivity disorder (ADHD) was followed prospectively for two years. Controlling for baseline ADHD diagnostic status, initial CP, and negative parenting (i.e., corporal punishment), we examined CU traits, positive reinforcement and involvement, and their interactions as predictors of two-year change in CP. Positive reinforcement and CU traits independently predicted increased rule breaking behavior whereas parental involvement inversely predicted aggressive behavior. A significant positive reinforcement x CU traits interaction suggested that positive reinforcement predicted a decrease in aggressive behavior, but only in children with low CU traits; conversely, positively reinforcement marginally predicted increased aggressive behavior among children with high CU traits. No other significant parenting x CU traits interaction was observed. We consider these findings within a developmental psychopathology framework where interactive exchanges underlie the development of CP.

The personality dispositions and resting-state neural correlates associated with aggressive children

Despite aggression being detrimental to children's physical health, mental health and social development, the dispositional and neurological antecedents of aggression in the child are poorly understood. Here we examined the relationship between trait aggression as measured by Buss and Warren's Aggression Questionnaire and personality traits measured with Big Five Questionnaire for Children in 77 primary-school children and recorded resting-state brain activity (fractional amplitude of low-frequency fluctuations [fALFF]) and resting-state functional connectivity (rsFC) using functional magnetic resonance imaging. The present results showed that trait aggression was negatively correlated with agreeableness and positively correlated with neuroticism. The brain analyses showed that children with a higher propensity for aggression had a lower fALFF mainly in the left superior temporal gyrus, right parahippocampal gyrus and left supramarginal gyrus. Physical and total aggressions were negatively associated with rsFC between the right parahippocampal gyrus and the right putamen. Further analysis revealed that this rsFC could moderate the influence of neuroticism on total aggression. Moreover, the results suggest the presence of a sex difference in the neurodevelopmental mechanisms underlying aggression in middle childhood. Overall, our findings indicate that aggressive children have lower agreeableness and higher neuroticism, and the underlying neural systems are mainly implicated in social judgment and empathy.

Childhood maltreatment, serotonin transporter gene, and risk for callous and unemotional traits: A prospective investigation

Previous studies have reported associations between the serotonin transporter 5-HTTLPR genotype and antisocial and aggressive traits and between child maltreatment and antisocial traits. However, few studies have examined whether 5-HTTLPR moderates the influence of childhood maltreatment on callous and unemotional traits, a hallmark of psychopathy. Using a prospective cohort design, children with documented cases of maltreatment and matched controls were followed up and interviewed in adulthood. DNA was extracted from blood and saliva (N = 414) and callous-unemotional (CU) traits were assessed. Childhood maltreatment predicted higher CU scores in adulthood, whereas the effect of 5-HTTLPR was not significant. The effect of child maltreatment on CU traits did not differ by genetic risk (high or low activity 5-HTTLPR), whereas controls with the LL genotype had higher CU scores than controls with the SS genotype. Similar results were found for females and White, non-Hispanics, but not for males and Blacks. Variations in 5-HTTLPR did not affect the impact of child maltreatment on CU traits in adulthood. Genetic risk had a stronger effect on adults with lower environmental risk (controls). Having a history of child maltreatment or the LL genotype placed participants at risk for higher levels of callous and unemotional trait scores.

Autonomic nervous system activity and callous-unemotional traits in physically maltreated youth

BACKGROUND

Research into callous-unemotional (CU) traits often focuses exclusively on biological risk factors without integrating social factors. This gap exists despite a growing body of research showing that the social environment may actually impact physiological functioning, which could in turn affect behavior.

OBJECTIVE

The current study addresses this limitation by examining physical maltreatment and heart rate stress reactivity as potential risk factors for CU traits.

PARTICIPANTS AND SETTING

This research was conducted in a community sample of Chinese youth (mean age = 11.83 years, 44.3 % female).

METHODS

Each child separately reported frequency of physical maltreatment experiences by his or her mother and father over the past 12 months. Children completed a self-report measure of CU traits.

RESULTS

Frequency of maternal physical maltreatment was associated with uncaring traits in females, but not in males. Paternal physical maltreatment was associated with uncaring traits in both males and females and with callous traits in females only. While paternal physical maltreatment was associated with lower heart rate reactivity in females, maternal physical maltreatment was associated with higher heart rate reactivity in females.

CONCLUSION

Findings provide mixed support for a potential physiological pathway through which child maltreatment may impact callous traits and provide a multilevel, biosocial lens through which to understand CU traits.

Reducing reactive aggression in schoolchildren through child, parent, and conjoint parent-child group interventions: An efficacy study of longitudinal outcomes

This study was the first to evaluate the effectiveness of three different group interventions to reduce children's reactive aggression based on the social information processing (SIP) model. In the first stage of screening, 3,734 children of Grades 4-6 completed the Reactive-Proactive Aggression Questionnaire (RPQ) to assess their reactive and proactive aggression. Respondents with a total score of z ≥ 1 on the RPQ were shortlisted for the second stage of screening by qualitative interview. Interviews with 475 children were conducted to select those who showed reactive aggression featuring a hostile attributional bias. Finally, 126 children (97 males and 29 females) aged 8 to 14 (M = 9.71, SD = 1.23) were selected and randomly assigned to one of the three groups: a child group, a parent group, and a parent-child group. A significant Time × Intervention effect was found for general and reactive aggression. The parent-child group and child group showed a significant drop in general aggression and reactive aggression from posttest to 6-month follow-up, after controlling for baseline scores, sex, and age. However, the parent group showed no treatment effect: reactive aggression scores were significantly higher than those in the child group at 6-month follow-up. This study has provided strong evidence that children with reactive aggression need direct and specific treatment to reconstruct the steps of the SIP involving the selection and interpretation of cues. The intervention could help to prevent severe violent crimes at the later stage of a reactive aggressor.

Two subtypes of psychopathic criminals differ in negative affect and history of childhood abuse

OBJECTIVE

Specification of the etiological mechanisms underlying psychopathy is a key step in developing more effective methods for preventing and remediating the callous and impulsive behavior that characterizes the disorder. Theoretical conceptualizations of psychopathic subtypes propose that a primary variant largely stems from impoverished affect, whereas a secondary variant is hypothesized to develop subsequent to adverse environmental experiences (e.g., childhood maltreatment). However, there has been a dearth of research demonstrating that psychopathic subtypes actually differ in terms of experienced childhood maltreatment in an adult offender population.

METHOD

The current study employed model-based cluster analysis (MBCA) in a sample of incarcerated, psychopathic males (n = 110) to identify subtypes of psychopathic offenders based on a broad personality assessment.

RESULTS

Two subgroups emerged: 1 with high levels of negative affect (high-NA) and 1 with low levels of negative affect (low-NA). The high-NA subgroup scored significantly higher on measures of childhood maltreatment.

CONCLUSION

These results provide support for theoretical conceptualizations of psychopathic subtypes, suggesting that psychopathic offenders with high levels of negative affect experience a greater degree of childhood maltreatment. (PsycINFO Database Record

Callous unemotional traits and the relationship between aggressive parenting practices and conduct problems in Singaporean families

Research into parenting influences on child conduct problems in Asian countries has been limited compared to that conducted in Western countries, especially with regard to interplay between parenting and callous unemotional (CU) traits (e.g., lack of guilt and empathy). This study examined associations between dimensions of aggressive parenting practices (psychological aggression, mild and severe physical aggression), dimensions of child aggression (proactive, reactive), and child CU traits, in Singapore. Participants were children and adolescents with clinic-referred externalizing problems (N = 282; 87.6% boys), aged 7-16 years. Mild and severe parental physical aggression was found to be uniquely associated with children's proactive aggression, whereas parental psychological aggression was uniquely associated with both proactive and reactive aggression. Consistent with previous evidence regarding CU traits as moderators of the relationship between negative parenting and child conduct problems, physically aggressive parenting was found to be more strongly associated with children's proactive aggression among children with low levels of CU traits, than those with high CU traits. These findings support the need for ongoing research into CU traits in Asian cultures, focused on heterogeneous risk pathways to antisocial behavior and individual differences in response to family-based interventions.

Evaluation of Improvement in Externalizing Behaviors and Callous-Unemotional Traits in Children with Disruptive Behavior Disorder: A 1-Year Follow Up Clinic-Based Study

Multi-component interventions based on cognitive behavioral principles and practices have been found effective in reducing behavioral problems in children with disruptive behavior disorders (oppositional defiant disorder and conduct disorder). However, it is still unclear if these interventions can affect children's callous-unemotional traits, which are predictive of subsequent antisocial behavior. Furthermore, it could be important to identify empirically supported treatment protocols for specific disorders addressed by child mental health services. The present study aimed to test the following two hypotheses: first, the Coping Power (CP) treatment program is able to reduce externalizing behaviors in children with disruptive behavior disorders treated in a mental health care unit; second, the CP program can reduce children's callous unemotional traits. The sample included 98 Italian children, 33 treated with the CP program; 37 with a less focused multi-component intervention, and 28 with child psychotherapy. The results showed that the CP program was more effective than the other two treatments in reducing aggressive behaviors. Furthermore, only the CP program was associated with a decrease in children's callous unemotional traits. The CP program was also associated with lower rate of referrals to mental health services at one-year follow-up. These findings support the importance of disseminating manualized and focused intervention programs in mental health services.

Research Review: What do we know about psychopathic traits in children?

BACKGROUND

Research on the topic of child psychopathy has advanced over the past decade increasing what we know.

METHOD

This qualitative review examines the research base for child psychopathy and emphasizes its three dimensions: grandiose-manipulative, callous-unemotional, and daring-impulsive. Literature is reviewed addressing the cognitive, emotional, motivational, personality, parenting, and biological correlates.

RESULTS

Support has emerged for the phenotypic construct of child psychopathy, while questions remain regarding definitional issues and key external correlates (e.g., reward and punishment processing, parenting, molecular genetics, brain imaging).

CONCLUSIONS

While the construct appears to be valid, future work should broaden its focus from callous unemotional traits to all three dimensions of the construct, enhance measurement precision, and examine dimension interactions. Such research could have important implications for CD specification for future versions of the DSM and ICD and speed etiological knowledge and clinical care for youth with conduct problems.

Conduct disorders and psychopathy in children and adolescents: aetiology, clinical presentation and treatment strategies of callous-unemotional traits

Conduct Disorder (CD) is a psychiatric diagnosis characterized by a repetitive and persistent pattern of behaviour in which the basic rights of others and major age-appropriate social norms or rules are violated. Callous Unemotional (CU) traits are a meaningful specifier in subtyping CD for more severe antisocial and aggressive behaviours in adult psychopathology; they represent the affective dimension of adult psychopathy, but they can be also detected in childhood and adolescence. The CU traits include lack of empathy, sense of guilt and shallow emotion, and their characterization in youth can improve our diagnostic, prognostic and therapeutic abilities. A strong genetic liability, in interaction with parenting and relevant environmental factors, can lead to elevated levels of CU traits in children. We pointed out that CU traits can be detected in early childhood, may remain stable along the adolescence, but a decrease following intensive and specialized treatment is possible. We here provide a narrative review of the available evidences on CU traits in three main domains: aetiology (encompassing genetic liability and environmental risk factors), presentation (early signs and longitudinal trajectories) and treatments.

Conduct problems in youth and the RDoC approach: A developmental, evolutionary-based view

Problems related to aggression in young people are traditionally subsumed under the header of conduct problems, which include conduct disorder and oppositional defiant disorder. Such problems in children and adolescents are an important societal and mental health problem. In this paper we present an evolutionarily informed developmental psychopathology view of conduct problems inspired by the NIMH Research Domain Criteria (RDoC) initiative. We assume that while there are many pathways to conduct problems, chronic or temporary impairments in the domain of social cognition or mentalizing are a common denominator. Specifically, we conceptualize conduct problems as reflecting temporary or chronic difficulties with mentalizing, that is, the capacity to understand the self and others in terms of intentional mental states, leading to a failure to inhibit interpersonal violence through a process of perspective-taking and empathy. These difficulties, in turn, stem from impairments in making use of a normally evolutionarily protected social learning system that functions to facilitate intergenerational knowledge transmission and protect social collaborative processes from impulsive and aggressive action. Temperamental, biological, and social risk factors in different combinations may all contribute to this outcome. This adaptation then interacts with impairments in other domains of functioning, such as in negative and positive valence systems and cognitive systems. This view highlights the importance of a complex interplay among biological, psychological, and environmental factors in understanding the origins of conduct problems. We outline the implications of these views for future research and intervention.

Cyberbullying perpetration and victimisation among junior and senior high school students in Guangzhou, China

OBJECTIVES

Cyberbullying research in China is in early stage. This study describes the cyberbullying experiences of junior and senior high school students in Guangzhou, China, and to examine the risk factors associated with cyberbullying perpetrators, victims and perpetrator-victims among students. We also investigated the frequency of cyberbullying and coping strategies of student victims.

METHODS

Participants were 2590 students in grades 7, 8, 9 and 10 from six junior and senior high schools in October 2015 in Guangzhou, in south China, who completed a questionnaire. Data on participants' experiences with cyberbullying perpetration and victimisation during the previous 6 months were collected. Multinomial logistic regression was used to analyse factors associated with being perpetrators, victims and perpetrator-victims.

RESULTS

In this sample, 28.0% (725) of participants reported being a perpetrator and 44.5% (1150) reported being a victim in the previous 6 months. Specifically, 2.9% (74) reported being perpetrators only, 19.3% (499) reported being victims only and 25.2% (651) reported being perpetrator-victims (both perpetrator and victim). In addition, flaming was the most common form of cyberbullying in both perpetration and victimisation. Logistic regression analyses indicated that online game addiction in participants was associated with increased odds of being a perpetrator only; no democratic parenting style in the mother and physical discipline by parents were associated with increased odds of being a victim only; male students, students with low academic achievement, those spending over 2 hours a day online, experiencing physical discipline from parents and online game addiction were associated with increased odds of both perpetration and victimisation.

CONCLUSIONS

Cyberbullying is a common experience among Chinese junior and senior high school students. These findings add to the empirical data on cyberbullying and reinforce the urgent need for cyberbullying prevention in China. Furthermore, from the perspective of practice, it is important to raise our awareness of cyerbullying and reduce the risk factors.

Positive Parenting and Callous-Unemotional Traits: Their Association With School Behavior Problems in Young Children

The current study tested the associations of both positive (i.e., warm and responsive) and negative (i.e., harsh and inconsistent) aspects of parenting with callous-unemotional (CU) traits and conduct problems. Caregivers and teachers of 92 ethnically diverse (33% African American) kindergarten students (61% female) were recruited to complete a series of survey measures. Students' average age was 6.2 (SD = 0.42) years. Parent report of positive parenting practices, but not negative parenting practices, was associated with teacher report of conduct problems. Further, positive parenting interacted with CU traits in their association with conduct problems. Parental use of positive reinforcement was more strongly negatively related to conduct problems for youth with high levels of CU traits, whereas parent-child cooperation was positively related to conduct problems only for youth with low levels of CU traits. Finally, only parental warmth was negatively correlated with CU traits after controlling for level of conduct problems. Results were generally not moderated by the child's gender or ethnicity. These findings highlight the importance of positive parenting practices for understanding CU traits and as potential targets in clinical interventions to treat children who show elevated levels of these traits.

Digit ratio (2D:4D) and psychopathic traits moderate the effect of exogenous testosterone on socio-cognitive processes in men

Recent evidence suggests that testosterone is negatively correlated with empathic processes in both men and women. Also, administration of testosterone to young women impairs socio-cognitive performance as assessed using the "Reading the Mind in the Eyes Task", especially among those exposed to elevated testosterone concentrations prenatally. However, the extent to which testosterone plays a similar causal role in socio-cognitive abilities in men is currently unknown. Here, using a crossover, double-blind, placebo-controlled, within-subject design, we investigated the extent to which a single administration of testosterone to healthy young men (N=30) would impair socio-cognitive abilities assessed using the "Reading the Mind in the Eyes Task" (RMET). Also, we investigated whether individual differences in 2D:4D ratio and psychopathic traits would moderate the effect of testosterone on task performance. Results indicated that testosterone administration on its own did not impair RMET performance. However, variability in both 2D:4D ratio and psychopathic traits moderated the effect of testosterone on task performance. Specifically, testosterone impaired RMET performance among individuals with relatively low (i.e., masculinized) 2D:4D ratio and among individuals scoring relatively low on the interpersonal/affective facet (i.e., Factor 1) of psychopathy. Our findings highlight the importance of considering theoretically- and empirically-based individual difference factors when attempting to characterize the neuroendocrine mechanisms underlying socio-cognitive processes.

Annual research review: A developmental psychopathology approach to understanding callous-unemotional traits in children and adolescents with serious conduct problems

Recent research has suggested that the presence of significant levels of callous-unemotional (CU) traits designates a clinically important and etiologically distinct subgroup of children and adolescents with serious conduct problems. Based on this research, CU traits have been included in the most recent revision of the Diagnostic and Statistical Manual of Mental Disorders-5th Edition (DSM-5; American Psychiatric Association, 2013)--as a specifier for the diagnosis of conduct disorder. In this review, we attempt to understand CU traits within a developmental psychopathological framework. Specifically, we summarize research on the normal development of the prosocial emotions of empathy and guilt (i.e., conscience) and we illustrate how the development of CU traits can be viewed as the normal development of conscience gone awry. Furthermore, we review research on the stability of CU traits across different developmental periods and highlight factors that can influence this stability. Finally, we highlight the implications of this developmental psychopathological framework for future etiological research, for assessment and diagnostic classification, and for treatment of children with serious conduct problems.

Predicting aggression in children with ADHD

OBJECTIVE

The present study uses structural equation modeling of latent traits to examine the extent to which family factors, cognitive factors and perceptions of rejection in mother-child relations differentially correlate with aggression at home and at school.

METHODS

Data were collected from 476 school-age (7-15 years old) children with a diagnosis of ADHD who had previously shown different types of aggressive behavior, as well as from their parents and teachers. Structural equation modeling was used to examine the differential relationships between maternal rejection, family, cognitive factors and aggression in home and school settings.

RESULTS

Family factors influenced aggression reported at home (.68) and at school (.44); maternal rejection seems to be related to aggression at home (.21). Cognitive factors influenced aggression reported at school (.-05) and at home (-.12).

CONCLUSIONS

Both genetic and environmental factors contribute to the development of aggressive behavior in ADHD. Identifying key risk factors will advance the development of appropriate clinical interventions and prevention strategies and will provide information to guide the targeting of resources to those children at highest risk.

Callous-unemotional traits, proactive aggression, and treatment outcomes of aggressive children with attention-deficit/hyperactivity disorder

OBJECTIVE

Stimulant treatment improves impulse control among children with attention-deficit/hyperactivity disorder (ADHD). Decreased aggression often accompanies stimulant pharmacotherapy, suggesting that impulsiveness is integral to aggressive behavior in these children. However, children with high callous-unemotional (CU) traits and proactive aggression may benefit less from ADHD pharmacotherapy, because their aggressive behavior seems more purposeful and deliberate. This study's objective was to determine whether pretreatment CU traits and proactive aggression affect treatment outcomes among aggressive children with ADHD receiving stimulant monotherapy.

METHOD

We implemented a stimulant optimization protocol with 160 children 6 to 13 years of age (mean [SD] age of 9.31 [2.02] years; 78.75% male) with ADHD, oppositional defiant or conduct disorder, and significant aggressive behavior. Family-focused behavioral intervention was provided concurrently. The primary outcome was the Retrospective Modified Overt Aggression Scale. The Antisocial Process Screening Device and the Aggression Scale, also completed by parents, measured CU traits and proactive aggression, respectively. Analyses examined moderating effects of CU traits and proactive aggression on outcomes.

RESULTS

In all, 82 children (51%) experienced remission of aggressive behavior. Neither CU traits nor proactive aggression predicted remission (CU traits: odds ratio [OR] = 0.94, 95% CI = 0.80-1.11; proactive aggression, OR = 1.05, 95% CI = 0.86-1.29). Children whose overall aggression remitted showed decreases in CU traits (effect size = -0.379, 95% CI = -0.60 to -0.16) and proactive aggression (effect size = -0.463, 95% CI = -0.69 to -0.23).

CONCLUSIONS

Findings suggest that pretreatment CU traits and proactive aggression do not forecast worse outcomes for aggressive children with ADHD receiving optimized stimulant pharmacotherapy. With such treatment, CU traits and proactive aggression may decline alongside other behavioral improvements. Clinical trial registration information--Medication Strategies for Treating Aggressive Behavior in Youth With Attention Deficit Hyperactivity Disorder; http://clinicaltrials.gov/; NCT00228046; and Effectiveness of Combined Medication Treatment for Aggression in Children With Attention Deficit With Hyperactivity Disorder (The SPICY Study); http://clinicaltrials.gov/; NCT00794625.

Revisiting the treatment of conduct problems in children with callous-unemotional traits

OBJECTIVE

This study examined whether the diminished treatment response previously reported for children with conduct problems and high levels of callous-unemotional (CU) traits is evident when these traits are indexed using multi-informant data collected from mothers, fathers, and teachers. It also tested whether treatment outcomes associated with CU traits are independent of overlap between CU traits and autism spectrum disorder (ASD) symptoms.

METHOD

Diagnostic data on oppositional defiant disorder (ODD) severity were collected pre-treatment (time 1) and at 6-month follow-up (time 2) in a sample of children (N = 95; 67 boys, 28 girls) aged 3-9 years with clinic-referred conduct problems and comorbid symptoms in a range of diagnostic domains. Time 1 measures of CU traits and ASD symptoms were tested as predictors of time 2 ODD severity using structural equation modeling, with multi-informant ratings of CU traits modeled as a single latent variable.

RESULTS

Compared to children with low levels of CU traits, those with high levels exhibited more severe ODD symptoms at follow-up (β = 0.33, SE = 0.08, p < 0.05), after controlling for pre-treatment severity, socio-economic status, other demographics (age, gender), and parameters of treatment (number of treatment sessions, medication status). Although CU traits and ASD symptoms were positively correlated, ASD symptoms showed no association with change in ODD severity from pre-treatment to follow-up. Likewise, the association between CU traits and ODD outcomes held when controlling for covariation between CU traits and ASD symptoms.

CONCLUSIONS

Our findings replicate previous evidence that CU traits are uniquely associated with poor clinical outcomes among children treated for conduct problems, and show for the first time that this association is not accounted for by symptoms of ASD.

The Southern California Twin Register at the University of Southern California: III

The Southern California Twin Register at the University of Southern California (USC) was initiated in 1984 and continues to provide an important resource for studies investigating genetic and environmental influences on human behavior. This article provides an update on the current register and its potential for future twin studies using recruitment through school district databases and voter records. An overview is also provided for an ongoing longitudinal twin study investigating the development of externalizing psychopathology from childhood to young adulthood, the USC Study of Risk Factors for Antisocial Behavior. Characteristics of the twins and their families are presented, including recruitment and participation rates, as well as attrition analyses and a summary of key findings to date.