Interpersonal callousness and co-occurring anxiety: Developmental validity of an adolescent taxonomy

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.

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.

Dimensions of Warm Parenting Attributions Differentiate Conduct Problem Subtypes in Young Children

Understanding the developmental psychopathology of child conduct problems (CP) has been advanced by differentiating subtypes based on levels of internalizing problems (INT) and/or callous-unemotional (CU) traits (i.e., low empathy/guilt, poor motivation, shallow/deficient affect). The current study sought to elucidate prior inconsistencies in the role of warm/positive and harsh/negative parenting subcomponents in CP by differentiating subtypes on the basis of INT and CU traits. Parents of 135 young children (M age = 4.21 years, SD = 1.29) referred to specialty clinics for the treatment of CP completed pre-treatment measures of parenting and rated their child's levels of CP, INT, and CU traits. Results of planned comparisons revealed that mothers of children classified as secondary CU variants (high CU/ high INT) reported fewer overall warm attributions toward their child, compared with CP-only (low CU) children. They also reported a more negative dyadic relationship characterized by feelings of anger/hostility, active avoidance and/or a desire to do harm to their child relative to primary CU variants (high CU/ low INT). Mothers of primary CU variants attributed fewer good and altruistic intentions towards others in their child, relative to CP-only children. Subtypes were undifferentiated on observed positive and negative parenting behaviors, indicative of a disconnect between parenting behaviors and cognitions for mothers of children high on CU traits. Findings are discussed in relation to their theoretical and practice implications, and in guiding future research.

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.

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

OBJECTIVE

Recent efforts to improve outcomes for young children with conduct problems and callous-unemotional (CU) traits involve adapting treatments to meet the unique needs of this subgroup. However, these efforts have ignored accumulating evidence for distinct primary and secondary variants within the CU subgroup. Existing treatment adaptations uniformly target risk factors associated with primary CU traits and no studies have investigated variant-specific patterns of responsiveness to treatment adaptations among young children with CU-type conduct problems.

METHOD

Participants were 45 families with a 3- to 7-year-old clinic-referred child (M = 4.84 years, SD = 1.08, 84% boys) with conduct problems and CU traits. Primary and secondary CU variants were defined based on baseline parent-rated anxiety scores. All families received Parent-Child Interaction Therapy adapted for CU traits (PCIT-CU) at an urban university-based research clinic. Families completed five assessments measuring child conduct problems and affective outcomes.

RESULTS

Linear mixed-effects modeling showed that the rate and shape of change over time in conduct problems differed between variants, such that children with secondary CU traits showed deterioration in defiant and dysregulated behaviors from post-treatment to follow-up, whereas primary CU traits were associated with maintained gains. There were no variant differences in rate of improvement in CU traits. Affective empathy did not improve for either variant. Internalizing problems meaningfully improved by follow-up for children with secondary CU traits.

CONCLUSIONS

Findings suggest that PCIT-CU is a promising intervention for children with conduct problems and primary CU traits, but may require further personalization for children with secondary CU traits. This trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12616000280404).

Neural correlates of aggression in personality disorders from the perspective of DSM-5 maladaptive traits: a systematic review

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published in 2013, includes an alternative model of personality disorders (AMPD) focusing on a maladaptive trait model utilized to diagnose several personality disorders. Borderline personality disorder (BPD) and antisocial personality disorder (ASPD) are two conditions categorized by AMPD that exhibit high rates of violence and aggression. Several of the traits outlined in the AMPD, including hostility, impulsivity, risk-taking, and callousness, have been previously linked to aggression in BPD and ASPD. However, to the best of our knowledge, there has never been a synthesis of neuroimaging studies that have investigated links between these traits and aggression in BPD and ASPD. To overcome this gap, we conducted a systematic review under the PRISMA framework to locate neuroimaging articles published since the release of AMPD linking trait anger/hostility, impulsivity, risk-taking, and callousness to aggression in BPD and ASPD. Key findings included the following: i) anger/hostility, associated with alterations in the interplay between prefrontal and subcortical regions (primarily the amygdala), may be a common factor explaining aggressive reactions to response to interpersonal threat or provocation; ii) alterations of fronto-temporal-limbic regions and serotonergic and endocannabinoid signaling systems may link impulsivity to aggression in BPD and ASPD; iii) weaker cortico-striatal connectivity could relate to greater risk taking and greater proclivity for violence. Insufficient evidence from neuroimaging articles was discerned to describe a relationship between callousness and aggression. Overall, results of this review reveal a relative paucity of neuroimaging studies examining AMPD traits relevant to aggression in BPD and ASPD. In addition to encouraging further investigation of neuroimaging markers of AMPD traits linked to aggression, we recommend multi-methodological designs, including the incorporation of other biomarkers, such as hormones and indices of physiological arousal, to fully expand our understanding of aggression in BPD and ASPD.

Primary and Secondary Variants of Callous-Unemotional Traits in Early and Middle Childhood: Distinction, Evaluation and Empathic Differences

Current literature demonstrates the relevance of considering two variants of CU traits based on high or low levels of anxiety. However, there is limited information about these variants in young community samples. The current study used cluster analyses to investigate the primary and the secondary variants of CU traits in two samples of children: preschool (N = 107; Mage = 4.95, SD = 0.62) and school-age (N = 153; Mage = 7.49, SD = 1.11). The identified clusters were compared on empathic dimensions, aggressive behavior and criteria from the "with limited prosocial emotions" specifier from the DSM-V. The primary variant was identified as early as preschool age while the secondary variant was only identified in the school-age sample. In this latter sample, the two variants did not differ on assessed variables, except for aggressive behavior. Despite the similarities between the two variants, these results suggest distinct developmental trajectories.

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.

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.

Maternal mental-health treatment moderates the association between psychological distress and harsh parenting: A prospective cohort study

OBJECTIVE

Parental psychological distress (depression, anxiety) is detrimental to child mental health. A key reason for this is that depressed and anxious parents are at risk of engaging in more negative, reactive and harsh parenting. While treatment for psychological distress has a long history of success in adults, less is known about how treatment for parental psychological distress may positively influence parenting behaviours, particularly in the general population. We examined the moderating role of mothers receiving treatment for depression or anxiety on the longitudinal relationship between maternal psychological distress and the development of harsh parenting (smacking and shouting) across early childhood (ages 3 to 7).

METHOD

Using prospective data from 16,131 families participating in the UK's Millennium Cohort Study, we conducted moderator analysis within a multilevel repeated measures model to test whether receiving treatment for mental health problems could protect mothers with high psychological distress from engaging in harsh parenting.

RESULTS

In each wave, about 7% of mothers reported undergoing treatment for depression or anxiety at that time. Maternal psychological distress was associated with increased use of harsh parenting and that, adjusting for psychological distress, receiving psychological treatment was related to decreased use of harsh parenting. Importantly, receiving psychological treatment buffered the negative effect of psychological distress on harsh parenting.

CONCLUSION

In early-to-middle childhood, mental health treatment may help mothers with depression or anxiety to be less harsh toward their children, thereby benefiting their child's psychological adjustment.

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.

The Underlying Mechanisms in the Association Between Traumatic Brain Injury in Childhood and Conduct Disorder Symptoms in Late Adolescence

The present study examined i) the direct association between traumatic brain injury (TBI) in childhood and conduct disorder symptoms in adolescence, ii) whether this effect is mediated by impulsivity and/or callous unemotional traits (CU traits), and iii) whether these indirect effects are moderated by childhood family adversity and adolescent substance use. Utilising data from the Avon Longitudinal Study of Parents and Children (ALSPAC), participants with head injury information up to 12 years (4.5 years, 5.4 years, 6.5 years, 8.6 years, 11.7 years) were identified and categorised into a TBI (n = 409), orthopaedic injury (n = 1469) or non-injury group (n = 5685). Psychosocial factors such as impulsivity at 13 years, CU traits at 13 years, childhood family adversity (between birth to 4 years) and substance use at 14 years were collated for moderated mediation analyses. Conduct disorder symptoms were assessed at 16 years of age. TBI and conduct disorder symptoms were positively associated, and this association was mediated by impulsivity but not CU traits. The indirect effects were higher in magnitude for individuals with higher levels of childhood family adversity. Adolescent substance use was not found to moderate the indirect effects between TBI and conduct disorder symptoms. These results were specific to TBI individuals, and not in participants with orthopaedic injury and no reported injuries. Targeting impulsivity and early family adversity may alleviate the risk of conduct disorder symptoms following TBI in childhood. These findings have important implications for informing neuro-rehabilitative and preventative measures in clinical and community settings.

Perinatal and early-life factors associated with stable and unstable trajectories of psychopathic traits across childhood

BACKGROUND

This study aimed to identify perinatal and early-life factors associated with trajectories of psychopathic traits across childhood.

METHODS

Participants were 1631 children (51.5% girls) from the Quebec Longitudinal Study of Child Development. A wide range of perinatal and early-life factors were assessed from pregnancy to age 2.5 years using medical files and mothers' reports. Psychopathic traits were assessed via teachers' reports at ages 6, 7, 8, 10, and 12 years. Latent class growth analyses and multinomial logistic regressions controlling for child sex were conducted. Two-way interaction effects between perinatal/early-life factors and child sex were explored.

RESULTS

Four trajectories of psychopathic traits were identified: High-stable (4.48%), Increasing (8.77%), Decreasing (11.46%), and Low-stable (75.29%). A few perinatal factors and most child-level and family-level early-life factors significantly increased the odds of following the High-stable v. the Low-stable trajectory. Higher levels of psychotropic exposures during pregnancy, socioeconomic adversity, child's physical aggression, child's opposition, mother's depressive symptoms, and hostile parenting increased the likelihood of following the Increasing instead of the Low-stable trajectory. Higher socioeconomic adversity, mother's depressive symptoms, and inconsistent parenting were associated with membership to the High-stable instead of the Decreasing trajectory. Most associations were not moderated by child sex.

CONCLUSIONS

These results shed light on the perinatal and early-life factors that are associated with specific pathways of psychopathic traits during childhood and suggest that different factors could be targeted to prevent the exacerbation (v. low and stable levels) or the stability at high levels (v. attenuation) of these traits.

Community Violence Exposure and Generalized Anxiety Symptoms: Do Callous-Unemotional Behaviors Moderate this Relation Among Urban Youth?

Community violence exposure (CVE; i.e., direct victimization and witnessed violence) is a major public health concern among youth who reside in low income, urban neighborhoods, who tend to experience CVE chronically and disproportionately. Frequent CVE is associated with generalized anxiety disorder (GAD) symptoms, such as persistent or excessive worry and difficulty concentrating. However, not all youth experiencing CVE exhibit such symptoms. One understudied factor that may moderate this relation is callous-unemotional (CU) behaviors (e.g., behaviors consistent with lack of guilt, low levels of empathy). CU behaviors are associated with lower levels of responsiveness to contextual processes; as such, CU behaviors may be associated with lower levels of GAD symptoms in the context of CVE. However, little research considers CU behaviors and GAD symptoms concurrently. To address this gap, the present study examined associations among witnessed and direct CVE, CU behaviors, and GAD symptoms among low-income, urban youth (N = 104, 50% male, Mage = 9.93 ± 1.22 years old, 95% African-American/Black). Multiple regression analyses indicated teacher-reported CU behaviors moderated the relations between CVE and caregiver-reported GAD symptoms. Post-hoc probing revealed that among youth with higher levels of CVE, higher levels of CU behaviors were associated with elevated GAD symptoms compared to their peers with lower levels of CU behaviors. Youth with lower levels of CU behaviors evidenced moderate levels of GAD symptoms regardless of their levels of CVE. Thus, low-income, urban youth who experience elevated levels of CVE may be at increased risk for co-occurring GAD and CU symptoms.

Describing Callous Unemotional Traits and Stressful Life Event Trajectories: Differences on Risk Factors and Mental Health Outcomes from the Age of 3 to 10

Callous Unemotional (CU) traits are associated with different environmental risk factors, such as negative stressful life events (SLE). The most common studied SLE associated with CU trait has been childhood maltreatment, but less is known about how other SLE impact the development of CU traits. Therefore, this work examines risk factors, personal factors (executive functioning), and mental health outcomes associated with the trajectories of Callous Unemotional (CU) traits and Stressful Life Events (SLE) in a community sample of children. A cohort of 377 preschoolers were followed up between ages 3 and 10. Several risk factors and outcomes for three trajectory groups (high CU/SLE; high CU/low SLE; and the reference group with low CU/SLE) were analyzed by using multiple post-hoc comparisons. We hypothesized that children with high CU/SLE would face more contextual risk factors, more executive functioning difficulties and more mental health problems than children with high CU/low SLE or the reference group. At the age of 3, children who showed high CU/SLE faced more early contextual adversity, including socioeconomic difficulties and maternal antisocial behavior than the other groups of children. At the age of 10, children with high CU/SLE presented more peer problems and higher psychopathology symptoms than the reference group, but no differences on mental health outcomes in comparison to the high CU/low SLE group. These results have potential implications for clinical practice and studies attempting to identify different CU subtypes in children.

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.

Primary and Secondary Variants of Psychopathic Traits in at-Risk Youth: Links with Maltreatment, Aggression, and Empathy

The current study examined whether two variants of psychopathic traits (PT) were identifiable in high-risk youth who had not yet been identified as antisocial, some of whom had documented histories of maltreatment (N = 167, M_age = 14.84), and then whether the variants differed in levels of aggression and empathy. High-PT youth with low anxiety and trauma (i.e., primary variant PT) and high anxiety and trauma (i.e., secondary variant PT) were differentiated. The secondary variant group was comprised largely of youth with documented histories of maltreatment. This group of youth also reported higher levels of proactive and reactive aggression than did the primary variant youth and low-PT youth. All youth reported similar levels of affective empathy and only small differences in cognitive empathy emerged: Primary variant youth reported lower cognitive empathy than low-PT youth. Findings support generalization of two variant groups of youth with psychopathic traits to diverse, high-risk samples not already identified as antisocial and have important implications for policy and practice.

Variants of Psychopathic Traits Follow Distinct Trajectories of Clinical Features Among Children with Conduct Problems

Original definitions of psychopathy suggest the existence of two variants that present with distinct clinical features among antisocial adults, but whether these clinical differences originate early in life or emerge at some point during childhood remains uncertain. We examined if primary and secondary variants follow distinct developmental trajectories of theoretically relevant clinical features among children with conduct problems (CP). Participants were 370 children (40.3% girls) with CP initially aged 8.49 years old in average (s.d. = 0.93). Variants indicators (callous-unemotional [CU] traits and anxiety [ANX]) and clinical features were measured at six yearly assessments. A dual trajectory modelling approach was used to identify groups and group memberships were entered in conditional growth models predicting trajectories of clinical features. Four groups were identified: CP-only, anxious (CP + ANX), primary (CP + CU), and secondary (CP + CU + ANX). Both variants showed higher initial levels of impairment than the CP-only group on most features. Compared to the primary variant, membership to the secondary variant was associated with more stable patterns of CP, oppositional problems, narcissism-grandiosity and impulsivity-irresponsibility traits. Moreover, children from the secondary variant showed higher initial levels of impairment in terms of cognitive abilities, depression, victimization, and dependency to teachers, with non-significant effects on the slope parameters suggesting that these early differences persist across development. In addition to showing distinct clinical features relatively early in childhood, children from the secondary variant of psychopathic traits are at high risk of experiencing an increasing psychopathological burden across childhood. The early identification and treatment of these children therefore appears particularly important.

Multiple developmental pathways underlying conduct problems: A multitrajectory framework

In the past decades, there has been an overemphasis of a descriptive/behavioral approach to study conduct disorder. In an equifinal perspective, we aimed to examine the developmental multitrajectory groups of psychological features (irritability, interpersonal callousness, hyperactivity/impulsivity, and depressive-anxiety symptoms) and their associations with conduct problems. In a population-based cohort (n = 1,309 participants followed from 5 months to 17 years old), latent-class growth analysis was performed for each psychological feature to identify a two-trajectory model (from ages 6 to 12 years). Based on parameter estimates of the two-trajectory models for each of the four psychological features, a parallel process growth mixture model identified eight significant developmental patterns that were subsequently compared with typically developing children. Furthermore, we observed that while interpersonal callousness conferred an increased risk for childhood and adolescence conduct problems, its co-occurrence with hyperactivity/impulsivity, irritability, and/or depressive-anxiety symptoms heightened the general risk, but also predicted distinct subtypes of conduct problems (i.e., aggressive and rule-breaking behaviors). Thus, by studying complex developmental combinations of psychological features, we observed qualitatively distinct pathways towards conduct problems. A multitrajectory framework of psychological features should be considered as a significant step towards unveiling the multiple etiological pathways leading to conduct disorder and its substantial clinical heterogeneity.

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.

A meta-analysis of the associations between callous-unemotional traits and empathy, prosociality, and guilt

Antisocial behavior is harmful, financially costly to society, and hard to treat. Callous-unemotional (CU) traits, which predict greater risk for antisocial behavior, are defined in theoretical and diagnostic models as representing low empathy, guilt, and prosociality. However, no meta-analytic reviews have systematically integrated the findings of studies that have reported associations between measures of CU traits and empathy, guilt, or prosociality, or potential moderators of these associations, including gender, age, severity of antisocial behavior, and informant (i.e., self or other reports of measures). To address this gap in the literature, we conducted three separate meta-analyses exploring the association between CU traits and empathy, guilt, and prosociality. In follow-up analyses, we explored associations between CU traits and affective versus cognitive empathy. The results revealed statistically significant and moderate-to-large negative associations between measures of CU traits and empathy (ρ = -.57), guilt (ρ = -.40), and prosociality (ρ = -.66). The negative association between CU traits and cognitive empathy was stronger when the informant was a parent or teacher rather than the child, and in younger children. CU traits were also more strongly related to cognitive empathy than affective empathy when the informant was a parent or teacher rather than the child, and in younger children. The findings establish that CU traits are moderately-to-strongly correlated with the presence of callous (low empathy), uncaring (low prosociality), and remorseless (low guilt) behaviors.

Sex-dependent associations between maternal prenatal cortisol and child callous-unemotional traits: Findings from the Wirral Child Health and Development Study

BACKGROUND

Elevated maternal glucocorticoids during pregnancy may impact on fetal development in a sex-dependent way, leading to increased amygdala activation and increased risk for internalising disorders in females. Based on evidence implicating reduced amygdala activation in callous-unemotional (CU) traits, we predicted that elevated maternal cortisol in pregnancy would be associated with lower CU traits and elevated anxious-depressed symptoms, only in girls.

METHODS

Participants were 225 members of a stratified subsample within an epidemiological longitudinal cohort (WCHADS). Salivary cortisol was measured over two days at 32 weeks gestation (on waking, 30-min post-waking and during the evening) and the log of the area under the curve (LogAUC) was calculated as an index of diurnal cortisol. Mothers reported on child CU traits and anxious-depressed symptoms at 2.5, 3.5 and 5.0 years of age.

RESULTS

As predicted there was a sex of child by cortisol interaction (p < .001) whereby elevated maternal cortisol was associated with lower child CU traits, explaining 25% of the variance, in girls, but not in boys. This effect remained when controlling for relevant confounders and anxious-depressed symptoms. By contrast, elevated maternal cortisol did not predict higher anxious-depressed symptoms in girls.

CONCLUSIONS

The study adds to growing evidence for sex-dependent effects of elevated maternal cortisol during pregnancy on early child psychopathology, consistent with mediation by elevated amygdala activation. The conditions under which, in girls, this is associated with heightened responsiveness to others' distress characteristic of low CU traits, or with increased affective symptoms, require further study.

Health and Functional Outcomes for Shared and Unique Variances of Interpersonal Callousness and Low Prosocial Behavior

Previous factor-analytic studies identify significant comorbidity between interpersonal-callous (IC) traits and low prosocial behavior (LPB), which, in turn, is associated with high levels of childhood risk exposure and psychopathology. Longitudinal associations between IC, LPB, or their combination, and early-adult health and social functioning have not been investigated, however. Extending a previously-identified bifactor model within a prospective birth cohort, this study applied latent path analysis to test direct and indirect pathways (via adolescent delinquency, substance use, and physical activity) between these general and specific factors (age 13) and (i) emotional problems (age 18), (ii) physical health problems (age 18), and (iii) classification as 'not in education, employment, or training' (NEET; age 20). All models controlled for childhood adversity and IQ. Bifactor-specific estimates indicated that the residual IC factor did not reliably denote unique variance over and above a general factor (IC/LPB). IC/LPB itself was directly associated with NEET classification, while the residual LPB factor was associated with better emotional and physical health. IC/LPB also indirectly associated with emotional problems via greater adolescent delinquency, and with physical health problems via lower physical activity. In contrast, residual LPB variance was either non-significantly or negatively related to these adolescent domains. Findings indicate that the shared variance underlying IC and LPB confers an increased risk for poor health and functional outcomes in emerging adulthood, and highlight delinquency and physical inactivity as potential adolescent treatment targets that may mitigate the risk for health difficulties at high levels of this IC/LPB construct.

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.

Shared and unique variances of interpersonal callousness and low prosocial behavior

Although low prosocial behavior (LPB) items have been incorporated into youth measures of callousness, it remains unclear from current factor analytic findings whether callous traits and LPB are best operationalized as a common construct, or distinct dimensions. Using data from a population-representative birth cohort (N = 5,463), this study compared 4 latent factor structures for interpersonal callousness (IC; 6 items) and LPB (5 items) at age 13: (a) unidimensional; (b) two-factor; (c) higher-order (with 2 subfactors); and (d) bifactor (1 general and 2 specific residual factors). Alternative models distinguishing positively and negatively worded items were tested for comparative purposes. To assess the external validity of the factors that emerged from the best-fitting model, associations with early parenting styles and psychiatric comorbidities were examined. A bifactor model, achieving invariance for males and females, offered the best fit for these data. However, additional bifactor-specific indices suggested that the specific IC factor did not offer a unique contribution to the total variance over and above the general factor (IC/LPB). Of the remaining factors, IC/LPB was associated with higher levels of harsh parenting, externalizing and internalizing disorder, and social-cognitive difficulties, and lower levels of warm parenting. The LPB factor, meanwhile, was associated with greater social-cognitive difficulties and externalizing disorder, and lower maternal warmth, evoking a phenotype that may be more indicative of the autism spectrum than IC. These findings suggest that the shared variance underlying IC and LPB taps a severe psychiatric phenotype, while the residual variance for LPB may represent a distinct profile of social-cognitive dysfunction. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Variants of Psychopathy and the Dependence on Gender, Age, and Ethnic Background

The current study examines variants of psychopathy in a community sample of Dutch adolescents (N = 2,855, 57% male) using three dimensions of psychopathy and trait anxiety. Five subgroups were identified, two with high levels of psychopathic traits. The first seemed consistent with primary psychopathy, high on all dimensions, with additional low levels of anxiety, whereas the second showed elevated levels of anxiety, consistent with secondary psychopathy. Two variants low on psychopathic traits were identified: a low-risk variant and an anxious variant. Further, a moderaterisk group was found, with slightly above average psychopathy traits and average levels of mental health problems. The secondary psychopathy and the anxious variant reported the most problem behaviors. Boys, younger adolescents, and non-Western immigrant youth were overrepresented in the secondary group. These findings show that in a community sample psychopathy is a heterogeneous phenomenon.

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.