Does early childhood callous-unemotional behavior uniquely predict behavior problems or callous-unemotional behavior in late childhood?

Callous-unemotional behaviors and conduct problems in Chinese preschoolers: the moderating roles of surgency and gender

Introduction

Conduct problems in children are related to callous-unemotional (CU) behaviors. However, results of the relationships between CU behaviors and conduct problems among preschoolers mainly focused on Western countries, no studies have examined whether CU behaviors predict conduct problem in Chinese preschoolers. The primary objective of the current study therefore was to examine the associations between CU behaviors and conduct problems as well as the moderating effects of surgency and child gender in Chinese preschool children.

Methods

The present study randomly selected 2,154 children (1,043 boys, Mage = 56 months, SD = 10.47) from six kindergartens in Shanghai, People's Republic of China. Mothers rated children's surgency and teachers reported children's CU behaviors and conduct problems.

Results

Results demonstrated that CU behaviors were positively associated with conduct problems. Surgency and child gender significantly moderated these associations. Specifically, CU behaviors were positively associated with conduct problems, with a stronger effect found for high levels of surgency. CU behaviors had a positive association with conduct problems, with a stronger effect found for boys.

Discussion

This study indicate that temperament and gender characteristics influence conduct problems in preschoolers who exhibit high levels of CU behaviors. As well, the findings emphasize the significance of considering the meaning and implication of CU behaviors in Chinese culture.

Newborn Brain Function and Early Emerging Callous-Unemotional Traits

Importance

Children with high callous-unemotional traits are more likely to develop severe and persistent conduct problems; however, the newborn neurobiology underlying early callous-unemotional traits remains unknown. Understanding the neural mechanisms that precede the development of callous-unemotional traits could help identify at-risk children and encourage development of novel treatments.

Objective

To determine whether newborn brain function is associated with early-emerging empathy, prosociality, and callous-unemotional traits.

Design, Setting, and Participants

In this prospective, longitudinal cohort study, pregnant women were recruited from obstetric clinics in St Louis, Missouri, from September 1, 2017, to February 28, 2020, with longitudinal data collected until March 20, 2023. Mothers were recruited during pregnancy. Newborns underwent brain magnetic resonance imaging shortly after birth. Mothers completed longitudinal follow-up when the children were aged 1, 2, and 3 years.

Exposures

The sample was enriched for exposure to socioeconomic disadvantage.

Main Outcome and Measure

Functional connectivity between hypothesized brain regions was assessed using newborn-specific networks and voxel-based connectivity analyses. Children's callous-unemotional traits were measured using the Inventory of Callous-Unemotional Traits. Empathy and prosociality were assessed using the Infant and Toddler Socio-Emotional Assessment.

Results

A total of 283 children (mean [SD] gestational age, 38 [2] weeks; 159 male [56.2%]; 2 Asian [0.7%], 171 Black [60%], 7 Hispanic or Latino [2.5%], 106 White [38%], 4 other racial or ethnic group [1.4%]) were included in the analysis. Stronger newborn functional connectivity between the cingulo-opercular network (CO) and medial prefrontal cortex (mPFC) was associated with higher callous-unemotional traits at age 3 years (β = 0.31; 95% CI, 0.17-0.41; P < .001). Results persisted when accounting for parental callous-unemotional traits and child externalizing symptoms. Stronger newborn CO-mPFC connectivity was also associated with lower empathy and lower prosociality at ages 1, 2, and 3 years using multilevel models (β = -0.12; 95% CI, -0.21 to -0.04; P = .004 and β = -0.20; 95% CI, -0.30 to -0.10; P < .001, respectively).

Conclusions and Relevance

Newborn functional connectivity was associated with early-emerging empathy, prosociality, and callous-unemotional traits, even when accounting for parental callous-unemotional traits and child externalizing symptoms. Understanding the neurobiological underpinnings of empathy, prosociality, and callous-unemotional traits at the earliest developmental point may help early risk stratification and novel intervention development.

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.

Parenting Characteristics and Callous-Unemotional Traits in Children Aged 0-6 Years: A Systematic Narrative Review

There has been a growing interest in research examining the relationship between parenting and child callous-unemotional (CU) traits, particularly in early childhood. This study reviewed evidence from studies that investigated the relationship between parenting characteristics (e.g., caregiving beliefs, attitudes, behaviour or quality, or parental mental health) and callous-unemotional traits in children aged 0 to 6 years. A systematic search conducted according to PRISMA guidelines yielded 27 peer-reviewed articles. Analysis of the included articles suggested that there was strong evidence to support links between child CU traits and parenting characteristics (particularly, parental feelings about their child, warm parenting, and harsh/ inconsistent parenting). Taken together, the results of this review demonstrate the links between both positive and negative dimensions of parenting and CU traits in early childhood; however, mixed findings highlight the need for further research.

Maternal emotional intelligence and negative parenting affect are independently associated with callous-unemotional traits in preschoolers

Deficits in emotion intelligence (EI) are a key component of early-childhood callous-unemotional (CU) traits. Children's EI may be influenced by their mother's EI through both familial genetic and environmental mechanisms; however, no study has directly tested the role of maternal EI in the development of CU traits. This study investigated whether maternal EI had a direct relationship with children's CU traits when controlling for the potential influence of parenting affect and other psychiatric diagnoses. Mothers and their 3- to 5-year-old preschoolers (N = 200) were recruited as part of a parent-child interaction-emotion development therapy treatment trial for preschool clinical depression and comorbid psychopathology. Using data collected prior to treatment, regression models tested whether maternal EI was related to children's CU traits, which specific aspects of maternal EI were most strongly associated with CU traits, and whether associations held after accounting for observed parenting affect. Maternal EI (p < 0.005), specifically the ability to understand others' emotions (p < 0.01), was significantly associated with children's CU traits. This relationship was specific, as maternal EI did not predict depression or oppositional defiant disorder. Both maternal EI and observed negative parenting affect were independently and significantly related to CU traits (p < 0.05) in a combined model. Given that maternal EI and observed negative parenting affect were independent predictors of CU traits in preschoolers with comorbid depression, findings suggest that current treatments for CU traits that focus solely on improving parenting could be made more effective by targeting maternal EI and helping mothers better model emotional competence.

Nursing teachers' job burnout and teaching ability: The mediating role of social support based on the Person-Context interaction theory

BACKGROUND

Great attention has been attached to the quality of nursing along with the development of medical treatment, which gives rise to the higher demand for colleges to cultivate high-quality nursing students, as well as the higher standard for teaching performance of the nursing faculty.

OBJECTIVE

This study aimed to investigate the effect of teachers' job burnout on teaching ability among nursing teachers in Chinese colleges and to examine the mediating role of social support in this relationship based on the Person-context interaction theory.

DESIGN

A cross-sectional descriptive design has been adopted.

METHODS

From February to June 2021, a total of 416 Chinese nursing teachers from 27 colleges filled out the questionnaires with a response rate of 97.42%. The questionnaire included general demographic questionnaire, teaching ability in nursing scale, teacher burnout scale and social support scale. The data were analyzed by SPSS26.0 statistical software in terms of Pearson's correlation the Structural Equation Model (SEM) was adopted to test the mediating effect of social support between job burnout and teaching ability in nursing of nursing teachers using Mplus 8.3.

RESULTS

Job burnout of nursing teachers was negatively and significantly correlated with the teaching ability in nursing and social support (p < 0.01). And Structural Equation Model results showed that social support mediated the relationship between teacher burnout and teaching ability in nursing.

CONCLUSIONS

Social support could help nursing teachers manage their job burnout, and eventually help them overcome the negative impact of teachers' job burnout on teaching ability in nursing. Social support could promote the teaching ability of nursing teachers by playing an intermediary role between them.[Box: see text].

Callous-unemotional traits and externalizing problem behaviors in left-behind preschool children: the role of emotional lability/negativity and positive teacher-child relationship

BACKGROUND

Callous-unemotional traits and emotional lability/negativity of young children have been regarded as the markers of externalizing problem behaviors. Based on the sensitivity to threat and affiliative reward model and the general aggression model, emotional lability/negativity may act as a mediator in the relationship between callous-unemotional traits and externalizing problem behaviors. Additionally, a positive teacher-child relationship could act as a buffer given the parental absence in left-behind children. However, these links remain unexplored in left-behind preschool children. Therefore, this study explored the link between callous-unemotional traits of left-behind preschool children and externalizing problem behaviors, as well as the mediating role of emotional lability/negativity and the moderating role of a positive teacher-child relationship.

METHOD

Data were collected on 525 left-behind children aged 3 to 6 years from rural kindergartens in China. Preschool teachers reported all data through an online survey platform. Moderated mediation analysis was performed to examine whether the mediated relation between callous-unemotional traits and externalizing problem behaviors was moderated by a positive teacher-child relationship.

RESULTS

The results showed callous-unemotional traits significantly predicted externalizing problem behaviors and lability/negativity acted as a mediator, while a positive teacher-child relationship acted as a protective factor in moderating the relationship between callous-unemotional traits and emotional lability/negativity. This study identified a moderated mediation effect among the four variables in left-behind preschool children in China.

CONCLUSION

The findings provide support for the advancement of theoretical foundations, and provide an avenue for further exploration to support the mental health and overall development of left-behind children during early childhood.

The Mediating Role of Callous-Unemotional Traits in the Relationship between Parental Aggression and Behavioral Problems among Chinese Preschoolers

It is well known that aggressive parenting is associated with behavioral problems among Western children in their early childhood, but this has rarely been examined among Chinese preschoolers. The purpose of this study is to explore the relationship between aggressive parenting, callous-unemotional traits (CU traits), and behavioral problems among a large Chinese preschool sample. Data were collected in Wuhu city, China, from 1879 preschoolers (54% of whom were male) with a mean age of 65.66 months (standard deviation = 9.41). Parents provided information about the frequency of aggressive parenting, children's behaviors, and demographic characteristics via an online questionnaire. Mediation models were applied to analyze the associations between aggressive parenting, CU traits, and behavioral problems. Preschoolers' age, gender, and family socioeconomic status were considered as covariates. The findings of our study revealed that higher frequencies of parental psychological and physical aggression were associated with high levels of CU traits, which were related to increased levels of preschoolers' behavioral problems. This study extends previous studies by revealing a positive relationship between aggressive parenting and behavioral problems among Chinese preschoolers via CU traits and highlights the risks of aggressive parenting. Interventions for improving parenting strategies and lessening callous-unemotional traits should be developed to help reduce behavioral problems.

Associations of observed callous-unemotional behaviors in early childhood with conduct problems and substance use over 14 years

Callous-unemotional (CU) behaviors (i.e., low concern and active disregard for others) uniquely predict severe conduct problems and substance use when present by late childhood. Less is known about the predictive utility of CU behaviors displayed in early childhood, when morality is developing and interventions may be more effective. Children aged 4-7 years (N = 246; 47.6% girls) completed an observational task wherein they were encouraged to tear an experimenter's valued photograph, and blind raters coded children's displayed CU behaviors. During the next 14 years, children's conduct problems (i.e., oppositional defiant and conduct symptoms) and age of onset of substance use were assessed. Compared to children displaying fewer CU behaviors, children displaying greater CU behaviors were 7.61 times more likely to meet criteria for a conduct disorder (n = 52) into early adulthood (95% CI, 2.96-19.59; p = <.0001), and their conduct problems were significantly more severe. Greater CU behaviors were associated with earlier onset of substance use (B = -.69, SE = .32, t = -2.14, p = .036). An ecologically valid observed indicator of early CU behavior was associated with substantially heightened risk for conduct problems and earlier onset substance use into adulthood. Early CU behavior is a powerful risk marker identifiable using a simple behavioral task which could be used to target children for early intervention.

Synergy between callous-unemotional traits and aggression in preschool children: Cross-informant and cross-cultural replication in the UK Wirral Child Health and Development Study, and the Colombian La Sabana Parent-Child Study

Incremental prediction of aggression from callous-unemotional (CU) traits is well established, but cross-cultural replication and studies of young children are needed. Little is understood about the contribution of CU traits in children who are already aggressive. We addressed these issues in prospective studies in the United Kingdom and Colombia. In a UK epidemiological cohort, CU traits and aggression were assessed at age 3.5 years, and aggression at 5.0 years by mothers (N = 687) and partners (N = 397). In a Colombian general population sample, CU traits were assessed at age 3.5 years and aggression at 3.5 and 5.0 years by mother report (N = 220). Analyses consistently showed prediction of age-5.0 aggression by age-3.5 CU traits controlling for age-3.5 aggression. Associations between age-3.5 CU traits and age-5.0 aggression were moderated by aggression at 3.5 years, with UK interaction terms, same informant, β = .07 p = .014 cross-informant, β = .14 p = .002, and in Colombia, β = .09 p = .128. The interactions arose from stronger associations between CU traits and later aggression in those already aggressive. Our findings with preschoolers replicated across culturally diverse settings imply a major role for CU traits in the maintenance and amplification of already established aggression, and cast doubt on their contribution to its origins.

Facial Affect Sensitivity Training for Young Children with Emerging CU Traits: An Experimental Therapeutics Approach

OBJECTIVE

This article delineates best practices in the application of the experimental therapeutics framework for evaluating interventions within the context of randomized controlled trials (RCTs), offering a methodological primer and guiding framework for this approach. We illustrate these practices using an ongoing clinical trial conducted within the framework of a National Institute of Mental Health exploratory phased-innovation award for the development of psychosocial therapeutic interventions for mental disorders (R61/R33), describing the implementation of a novel "Facial Affect Sensitivity Training" (FAST) intervention for children with callous-unemotional (CU) traits. CU traits (e.g., lack of guilt or remorse, low empathy, shallow affect) are an established risk factor for persistent and severe youth misconduct, which reflect impairment in identified neurocognitive mechanisms that interfere with child socialization, and predict poor treatment outcomes, even with well-established treatments for disruptive behavior.

METHOD

We outline the stages, goals, and best practices for an experimental therapeutics framework. In the FAST trial, we assert that impaired sensitivity for emotional distress cues (fear and/or sadness) is mechanistically linked to CU traits in children, and that by targeting sensitivity to facial affect directly via a computerized automated feedback and incentive system, we can exert downstream effects on CU traits.

RESULTS

In the context of an open pilot trial, we found preliminary support for feasibility and mechanism engagement using FAST.

CONCLUSIONS

We summarize pilot study limitations and how they are being addressed in the R61/R33 RCTs, as well as challenges and future directions for psychosocial experimental therapeutics.

Low social affiliation predicts increases in callous-unemotional behaviors in early childhood

BACKGROUND

Callous-unemotional (CU) behaviors predict risk for aggression and rule-breaking. Low social affiliation (i.e. reduced motivation for and enjoyment of social closeness) is hypothesized to be a phenotypic marker for CU behaviors in early childhood. However, studies need to establish observational methods to objectively assess social affiliation as well as to establish parenting practices that can buffer pathways from low social affiliation to CU behaviors.

METHODS

Using data from a longitudinal twin study of 628 children (age 2, 47% females; age 3, 44.9% females), we examined reciprocal associations between observed social affiliation, CU behaviors, and oppositional-defiant behaviors. We tested whether positive parenting moderated associations over time.

RESULTS

We established that an observed measure of social affiliation derived from the Bayley's Behavior Rating Scale and Infant Behavior Record showed high inter-rater reliability and expected convergence with parent-reported temperament measures. Lower social affiliation at age 2 uniquely predicted CU behaviors, but not oppositional-defiant behaviors, at age 3. Finally, low social affiliation at age 2 predicted CU behaviors at age 3 specifically among children who experienced low, but not high, levels of parental positivity.

CONCLUSIONS

An objective rating scale that is already widely used in pediatric settings reliably indexes low social affiliation and risk for CU behaviors. The dynamic interplay between parenting and low child social affiliation represents an important future target for novel individual- and dyadic-targeted treatments to reduce risk for CU behaviors.

Childhood maltreatment and violent delinquency in Chinese juvenile offenders: Callous-unemotional traits as a mediator

BACKGROUND

Adolescents in China suffer a high prevalence of childhood maltreatment, which has been shown to facilitate juvenile violent delinquency. Studies have implicated a relationship between callous-unemotional traits and both juvenile violent delinquency and childhood maltreatment. However, the complex relationships among these three variables have not yet been examined.

OBJECTIVE

This study aimed to investigate the mediating role of callous-unemotional traits in the relationship between different types of childhood maltreatment and juvenile violent delinquency.

PARTICIPANTS AND SETTING

Childhood maltreatment and callous-unemotional traits were assessed in a sample of 441 juvenile violent offenders and a control group of 543 non-offenders, using questionnaires.

METHODS

After controlling for socio-economic status, a mediation analysis determined the direct, indirect, and total effect of the mediation of callous-unemotional traits in the relationship between childhood maltreatment and juvenile violent delinquency.

RESULTS

The results showed no mediation of callous-unemotional traits in the relationship between physical abuse and juvenile violent delinquency. However, callous-unemotional traits mediated the relationship between sexual abuse and juvenile violent delinquency as well as between emotional neglect and juvenile violent delinquency.

CONCLUSIONS

Our findings suggest that sexual abuse has both a direct and indirect effect on juvenile violent delinquency via callous-unemotional traits, whereas childhood emotional neglect had only an indirect effect on juvenile violent delinquency.

Role of Callous and Unemotional (CU) Traits on the Development of Youth with Behavioral Disorders: A Systematic Review

Numerous studies have shown that youth with behavioral disorders (BD) present an increased risk for developing severe and persistent antisocial behaviors in adulthood. Retrospective research notes that not all children and adolescents follow a negative trajectory and explains this heterogeneity in particular by the severity of CU traits. Our study examines how these traits affect the functioning of children and adolescents with BD. Method: A systematic literature review conducted through various databases and using different keywords made it possible to analyze 52 studies published from 2015 to 2020 that measured the bidirectional effects of CU traits on the functioning of young. Results: Out of the 52 studies, 47 analyzed links between CU traits and neurobiological or mental health, 20 examined family and school contexts, eight focused on social adjustment, 10 on social interactions and 19 measured links with cognitive functioning, especially executive functions. Conclusion: Consistent with previous recommendations in the field, our findings emphasize the importance of assessing the presence of UC traits in early childhood to prevent the emergence of comorbid disorders and to target multimodal (early) interventions to influence the life trajectories of youth with high CU traits.

The association between toddlerhood empathy deficits and antisocial personality disorder symptoms and psychopathy in adulthood

The present study examined empathy deficits in toddlerhood (age 14 to 36 months) as predictors of antisocial personality disorder (ASPD) symptoms and psychopathy measured by the Levenson Self-Report Psychopathy scale (Levenson, Kiehl, & Fitzpatrick, 1995) in adulthood (age 23 years) in 956 individuals from the Colorado Longitudinal Twin Study. Consistent with the hypothesis that antisocial behavior is associated with "active" rather than "passive" empathy deficits, early disregard for others, not lack of concern for others, predicted later ASPD symptoms. Early disregard for others was also significantly associated with factor 1 of the Levenson Self-Report Psychopathy Scale, which includes items assessing interpersonal and affective deficits, but not with factor 2, which includes items assessing impulsivity and poor behavioral control. The association between early disregard for others and psychopathy factor 2 was near zero after controlling for the shared variance between psychopathy factors 1 and 2. These results suggest that there is a propensity toward adulthood ASPD symptoms and psychopathy factor 1 that can be assessed early in development, which may help identify individuals most at risk for stable antisocial outcomes.

Sex differences in antisocial and aggressive disorders that onset in childhood and persist into adulthood

As many as 10.7% of males and 7.5% of females display early-onset, stable, antisocial and aggressive behavior (ESAAB). Most research has focused on males. These individuals are diagnosed with conduct disorder in childhood and antisocial personality disorder in adulthood, and a very few, almost all males, present the syndrome of psychopathy. ESAAB includes three subgroups: (1) conduct problems and callousness; (2) conduct problems, callousness, and anxiety; and (3) conduct problems. Heritability of the first two subtypes is high. This high heritability derives, at least in part, from genes involved in regulating serotonergic functioning early in life and to genotypes that confer sensitivity to trauma. The first subtype is rare and characterized by difficulty in face emotion recognition, especially fear and sadness, and hypoarousal as indexed by both autonomic and neural measures, and by structural brain abnormalities. By contrast, those with conduct problems, callousness, and anxiety are more common. They include a greater proportion of females and show hypersensitivity to threat that triggers reactive aggression and that is reflected in both autonomic and neural functioning. In sum, fewer females than males present ESAAB, but many characteristics, autonomic and neural correlates, and etiology are similar. Importantly, however, females with ESAAB play a critical role in the intergenerational transfer of antisocial behavior. Despite higher prevalence of EASSB in males than females, few sex differences in neural abnormalities have been identified.

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.

CAPE for measuring callous-unemotional traits in disadvantaged families: a cross-sectional validation study

Background: Callous-unemotional (CU) traits are important for designating a distinct subgroup of children and adolescents with behaviour problems.  As a result, CU traits are now used to form the specifier "with Limited Prosocial Emotions" that is part of the diagnostic criteria for the Conduct Disorder in the Diagnostic and Statistical Manual of Mental Disorders 5 th Edition (DSM-5) and International Classification of Diseases 11 th Revision (ICD-11).  Given this inclusion in major classification systems, it is important to develop and test methods for assessing these traits that can be used in clinical settings.  The present study aimed to validate a clinician rating of CU traits, the Clinical Assessment of Prosocial Emotions, Version 1.1 (CAPE 1.1), in a sample of hard-to-reach families referred to a government program designed to prevent the development of behaviour problems in high risk families. Methods: Clinical ratings of children were obtained from 34 families of children ages 5 to 18 (M=13.5; SD=3.2). The ratings on the CAPE 1.1 were based on interviews with both parent and child. Results: Of the sample, 21% (100% male) met the diagnostic cut-off for the specifier according to the CAPE 1.1, and CAPE 1.1 scores were associated with parent ratings of CU traits, psychopathic traits, and externalising behaviours. CAPE 1.1 ratings were also associated with risk for violence obtained from case files.  Conclusions: These findings provide preliminary evidence for the validity of the CAPE 1.1 as clinician rated measure of CU traits.

Longitudinal Links Between Callous-Unemotional Behaviors and Parenting in Early Childhood: A Genetically Informed Design

OBJECTIVE

Most research on callous-unemotional behaviors (CU) and parenting does not focus on directions of effect, and work that does so has not been genetically informed. The present study is the first to examine potential reciprocal effects between parenting and CU in a community sample of early childhood. Use of a twin sample also allows us to distinguish child-based genetic effects from environmentally driven effects, which is necessary before translating this research to interventions.

METHOD

The present study used biometric cross-lagged models to investigate the relation between CU and parenting in twins at 2 and 3 years of age (monozygotic = 145, dizygotic = 169 twin pairs). CU was assessed using the parent-reported Child Behavior Checklist 1.5-5. Scores were residualized to control for conduct problems assessed on the Revised Rutter Parent Scale for Preschool Children. Parents' reports of negative and positive parenting were obtained using parent ratings of discipline and parent feelings from the Parent Feelings Questionnaire.

RESULTS

CU and negative parenting were significantly correlated at both ages. Cross-lagged analyses revealed a unidirectional effect with CU at age 2 years predicting negative parenting at age 3 years. These child-driven effects were primarily genetically mediated, although there were modest nonshared environmental contributions. CU and positive parenting were not consistently correlated, and further biometric analyses were not performed.

CONCLUSION

Children's genetically influenced CU behaviors can have an impact on the parenting that they experience. Child-driven CU effects, although less examined in the literature, are important and should receive more attention in future work.

Longitudinal Association Between Children's Callous-Unemotional Traits and Social Competence: Child Executive Function and Maternal Warmth as Moderators

This study examined the longitudinal association between children's early callous-unemotional (CU) traits and social competence in the transition to school-age, and tested whether this relationship was moderated by child executive function and maternal warmth. Participants were 643 children (49% girls) who were part of the Panel Study on Korean Children (PSKC) of the Korea Institute of Child Care and Education (KICCE). Mothers rated children's CU at 5 years and executive function at 8 years, and maternal warmth at 5 years. Teachers reported on children's social competence at 8 years. Results of the model including child executive function as the moderator indicated that deficits in child executive function and child sex (boys) predicted lower social competence. In addition, the moderating effect of executive function on the relationship between CU and social competence approached a trend such that CU predicted lower social competence only for children with lower executive function. In the model that included maternal warmth as a moderator, CU traits was associated with lower social competence, and this effect was more pronounced for boys as indicated by a significant effects of CU × child sex on social competence. The findings are discussed with respect to considering individual and contextual factors by which early CU becomes associated with individual differences in children's social competence.

A Systematic Literature Review of Neuroimaging of Psychopathic Traits

INTRODUCTION

Core psychopathy is characterized by grandiosity, callousness, manipulativeness, and lack of remorse, empathy, and guilt. It is often comorbid with conduct disorder and antisocial personality disorder (ASPD). Psychopathy is present in forensic as well as prison and general populations. In recent years, an increasing amount of neuroimaging studies has been conducted in order to elucidate the obscure neurobiological etiology of psychopathy. The studies have yielded heterogenous results, and no consensus has been reached.

AIMS

This study systematically reviewed and qualitatively summarized functional and structural neuroimaging studies conducted on individuals with psychopathic traits. Furthermore, this study aimed to evaluate whether the findings from different MRI modalities could be reconciled from a neuroanatomical perspective.

MATERIALS AND METHODS

After the search and auditing processes, 118 neuroimaging studies were included in this systematic literature review. The studies consisted of structural, functional, and diffusion tensor MRI studies.

RESULTS

Psychopathy was associated with numerous neuroanatomical abnormalities. Structurally, gray matter anomalies were seen in frontotemporal, cerebellar, limbic, and paralimbic regions. Associated gray matter volume (GMV) reductions were most pronounced particularly in most of the prefrontal cortex, and temporal gyri including the fusiform gyrus. Also decreased GMV of the amygdalae and hippocampi as well the cingulate and insular cortices were associated with psychopathy, as well as abnormal morphology of the hippocampi, amygdala, and nucleus accumbens. Functionally, psychopathy was associated with dysfunction of the default mode network, which was also linked to poor moral judgment as well as deficient metacognitive and introspective abilities. Second, reduced white matter integrity in the uncinate fasciculus and dorsal cingulum were associated with core psychopathy. Third, emotional detachment was associated with dysfunction of the posterior cerebellum, the human mirror neuron system and the Theory of Mind denoting lack of empathy and persistent failure in integrating affective information into cognition.

CONCLUSIONS

Structural and functional aberrancies involving the limbic and paralimbic systems including reduced integrity of the uncinate fasciculus appear to be associated with core psychopathic features. Furthermore, this review points towards the idea that ASPD and psychopathy might stem from divergent biological processes.

Early life predictors of callous-unemotional and psychopathic traits

Psychopathy is a disorder that occurs primarily in males. Offenders with psychopathic traits are responsible for a disproportionate amount of crime in society, particularly violent crime. Early childhood is a time when individual differences in empathy and guilt-key indicators of the construct of psychopathy-are first evident. A growing number of longitudinal studies have begun to investigate how factors in infancy and early childhood predict psychopathic-like traits in later childhood, adolescence, and adulthood. These studies have suggested that parenting styles during infancy (parental sensitivity, maternal harsh intrusion, commenting on the emotional state of the child) as well as attachment styles are predictive of later psychopathic-like traits. In addition, child characteristics such as temperament and the functioning of biological systems such as the autonomic nervous system and hypothalamic-pituitary-adrenal axis are predictive. Overall, studies have suggested that at least some of the origins of psychopathic traits are present in infancy and early childhood, which is consistent with the perspective of psychopathy as a neurodevelopmental disorder. A recent evolutionary-developmental model provides hypotheses regarding how psychopathy may develop and why it is more common in males than females. This model, and its implications for intervention, is discussed in the context of the longitudinal studies that have been conducted on psychopathy.

Parenting Is an Environmental Predictor of Callous-Unemotional Traits and Aggression: A Monozygotic Twin Differences Study

OBJECTIVE

Callous-unemotional (CU) traits increase risk for children to develop severe childhood aggression and conduct disorder. CU traits are typically described as highly heritable, and debate continues about whether the parenting environment matters in their etiology. Strong genetically informed designs are needed to test for the presence of environmental links between parenting practices and CU traits. Our objective was to determine whether parental harshness and parental warmth were related to children's aggression or CU traits when accounting for genetically mediated effects.

METHOD

We examined 227 monozygotic twin pairs (454 children) drawn from population-based and at-risk samples of twin families, leading to oversampling of twins living in poverty. We computed multi-informant difference scores combining mother and father reports of their harshness and warmth toward each twin, and differences in mother reports of each twin's aggression and CU traits.

RESULTS

Twin differences in parental harshness were related to differences in both aggression and CU traits, such that the twin who received harsher parenting had higher aggression and more CU traits. Differences in parental warmth were uniquely related to differences in CU traits, such that the twin receiving warmer parenting evidenced lower CU traits. These effects were not moderated by child sex, age, or family income, with the exception that the relationship between differential parental harshness and differential child aggression was stronger among low-income families.

CONCLUSION

Parenting is related to child CU traits and aggression, over and above genetically mediated effects, with low parental warmth being a unique environmental correlate of CU traits.

Associations of Psychopathic Traits With Local and Global Brain Network Topology in Young Adult Women

BACKGROUND

Psychopathic traits vary dimensionally in the population and are associated with multiple negative outcomes. The impaired integration theory (IIT) proposes that psychopathic traits are associated with abnormal neural network topology, such that disturbed integration of neural networks results in a self-perpetuating impairment in rapid integration and learning from multiple components of information. The IIT is based on findings from male offenders presenting high scores on all psychopathic traits. The present study investigated whether IIT predictions of topology abnormalities were associated with psychopathic traits, measured dimensionally, in young adult women with subsyndromal scores.

METHODS

Seventy-three women, with an average age of 25 years, were assessed using the Psychopathy Checklist-Revised and completed resting-state magnetic resonance imaging. Preprocessed time series from 90 anatomical regions were extracted to form connectivity matrices and used to calculate network topology based on graph theory. Correlations between total psychopathy and factor scores with both the raw connectivity matrix and global and local graph theory measures were computed.

RESULTS

Total psychopathy scores and behavioral factor scores were related to connectivity between several pairs of regions, primarily limbic/paralimbic. Psychopathic traits were not associated with global topology measures. Topology abnormalities, robust across network formation thresholds, were found in nodes of the default mode network and in hubs connecting several resting-state networks.

CONCLUSIONS

IIT predictions of abnormal topology of hubs and default mode network nodes with dimensionally measured psychopathic traits were confirmed in a sample of young women. Regional abnormalities, accompanied by preserved global topology, may underlie context-specific abnormal information processing and integration.

White matter correlates of psychopathic traits in a female community sample

Psychopathy comprises interpersonal, affective, lifestyle and antisocial facets that vary dimensionally in the population and are associated with criminal offending and adverse psychosocial outcomes. Evidence associating these facets with white matter microstructure of the uncinate fasciculus and the cingulum tracts is inconsistent and derives principally from studies of male offenders. In a sample of 99 young women presenting a range of scores on the Psychopathy Checklist: Screening Version, we used Diffusion Tensor Imaging, tractography and Tract-Based Spatial Statistics to investigate microstructure across the brain and of the uncinate fasciculus and cingulum. Right uncinate fasciculus microstructure was negatively associated with the interpersonal facet, while cingulum integrity was not associated with any facet of psychopathy. Whole-brain analyses revealed that both affective and lifestyle facets were negatively correlated with white matter microstructure adjacent to the fusiform gyrus, and the interpersonal facet correlated negatively with the integrity of the fornix. Findings survived adjustment for the other facet scores, and age, verbal and performance IQ. A similar negative association between the interpersonal facet and uncinate fasciculus integrity was previously observed in male offenders. Thus, previous evidence showing that psychopathic traits are associated with functional and structural abnormalities within limbic networks may also apply to females.

Callous-unemotional behaviors in early childhood: the development of empathy and prosociality gone awry

Callous-unemotional (CU) behaviors are critical to understanding the development of severe forms of aggression and antisocial behavior. CU behaviors include deficits in empathy and prosocial behavior, as well as reduced interpersonal responsivity to others. We review recent research examining CU behaviors in early childhood and the role that parents play in the development of early CU behaviors. We integrate research on the development of empathy and prosociality with that of CU behaviors to propose a developmental model of early CU behaviors that considers person-by-context interactions.

Understanding the development of psychopathy: progress and challenges

Psychopathy is an adult condition that incurs substantial societal and individual costs. Here we review neurocognitive and genetically informative studies that shed light on how and why this condition emerges. Children cannot present with psychopathy. However, the presence of callous-unemotional (CU) traits can distinguish a group of children who are at elevated risk of psychopathy in adulthood. These children display diminished empathy and guilt and show attenuated brain activation to distress cues in others. Genetically informative studies indicate that individual differences in CU traits show moderate-to-strong heritability, but that protective environmental factors can counter heritable risk. On the basis of the extant research findings, we speculate on what might represent the priorities for research over the next decade. We also consider the clinical implications of these research findings. In particular, we consider the importance of delineating what precisely works for children with CU traits (and their parents) and the ways in which intervention and prevention programs may be optimized to improve engagement as well as clinical outcomes.

Behavioural and emotional disorders in childhood: A brief overview for paediatricians

Mental health problems in children and adolescents include several types of emotional and behavioural disorders, including disruptive, depression, anxiety and pervasive developmental (autism) disorders, characterized as either internalizing or externalizing problems. Disruptive behavioural problems such as temper tantrums, attention deficit hyperactivity disorder, oppositional, defiant or conduct disorders are the commonest behavioural problems in preschool and school age children. The routine Paediatric clinic or Family Medicine/General Practitioner surgery presents with several desirable characteristics that make them ideal for providing effective mental health services to children and adolescents. DSM-5 and ICD-10 are the universally accepted standard criteria for the classification of mental and behaviour disorders in childhood and adults. The age and gender prevalence estimation of various childhood behavioural disorders are variable and difficult to compare worldwide. A review of relevant published literature was conducted, including published meta-analyses and national guidelines. We searched for articles indexed by Ovid, PubMed, PubMed Medical Central, CINAHL, EMBASE, Database of Abstracts and Reviews, and the Cochrane Database of Systematic reviews and other online sources. The searches were conducted using a combination of search expressions including "childhood", "behaviour", "disorders" or "problems". Childhood behaviour and emotional problems with their related disorders have significant negative impacts on the individual, the family and the society. They are commonly associated with poor academic, occupational, and psychosocial functioning. It is important for all healthcare professionals, especially the Paediatricians to be aware of the range of presentation, prevention and management of the common mental health problems in children and adolescents.

Attentional Orientation Patterns toward Emotional Faces and Temperamental Correlates of Preschool Oppositional Defiant Problems: The Moderating Role of Callous-Unemotional Traits and Anxiety Symptoms

The present study examined the independent contributions and the interaction effects of oppositional defiant problems (ODD), callous unemotional traits (CU) and anxiety symptoms on attentional orienting to emotional faces, in a community sample of preschoolers. Additionally, based on Rothbart's (2007) model of temperament, we analyzed whether fine-grained dimensions of reactivity (fear, anger, discomfort, sadness, activity level, approach, high intensity pleasure, impulsivity) and self-regulation (attentional shifting, attentional focusing, inhibitory control), as well as the higher order temperamental factors of negative affectivity, surgency and effortful control are associated with CU traits and ODD-related problems. Attentional orienting to emotional faces was assessed with pictorial Dot-probe task, while teachers rated CU traits and ODD-related problems. Also, parents reported on ODD-related problems, anxiety and temperament. Results indicated significant interaction effects between ODD-related problems and CU, as well as between CU and anxiety, in predicting attentional orientation patterns for angry, fearful and happy faces. Moreover, temperamental reactivity was positively associated with CU traits and ODD-related problems, whereas temperamental self-regulation was negatively related to CU traits and ODD-related problems. Results of this study have implications for early intervention and prevention approaches targeting preschool oppositional defiant problems.

The role of callous/unemotional traits in mediating the association between animal abuse exposure and behavior problems among children exposed to intimate partner violence

Children exposed to intimate partner violence are at increased risk for concomitant exposure to maltreatment of companion animals. There is emerging evidence that childhood exposure to maltreatment of companion animals is associated with psychopathology in childhood and adulthood. However, few studies have explored developmental factors that might help to explain pathways from animal maltreatment exposure to children's maladjustment. The present study addresses this gap in the literature by examining relations between children's exposure to animal maltreatment, callous/unemotional traits (i.e., callousness, uncaring traits, and unemotional traits), and externalizing and internalizing behavior problems. A sample of 291 ethnically diverse children (55% Latino or Hispanic) between the ages of 7 and 12 was recruited from community-based domestic violence services. A meditational path model indicated that child exposure to animal maltreatment was associated with callousness (β=0.14), which in turn was associated with greater internalizing (β=0.32) and externalizing problems (β=0.47). The effect of animal maltreatment exposure on externalizing problems was mediated through callousness. Results suggest that callous/unemotional traits are a potential mechanism through which childhood exposure to animal maltreatment influences subsequent behavior problems. Future research is needed to evaluate the extent to which exposure to animal maltreatment affects children's adjustment over time in the context of other co-occurring adverse childhood experiences.

Interactions between Callous Unemotional Behaviors and Executive Function in Early Childhood Predict later Aggression and Lower Peer-liking in Late-childhood

Callous unemotional (CU) behaviors are linked to aggression, behavior problems, and difficulties in peer relationships in children and adolescents. However, few studies have examined whether early childhood CU behaviors predict aggression or peer-rejection during late-childhood or potential moderation of this relationship by executive function. The current study examined whether the interaction of CU behaviors and executive function in early childhood predicted different forms of aggression in late-childhood, including proactive, reactive, and relational aggression, as well as how much children were liked by their peers. Data from cross-informant reports and multiple observational tasks were collected from a high-risk sample (N = 240; female = 118) at ages 3 and 10 years old. Parent reports of CU behaviors at age 3 predicted teacher reports of reactive, proactive, and relational aggression, as well as lower peer-liking at age 10. Moderation analysis showed that specifically at high levels of CU behaviors and low levels of observed executive function, children were reported by teachers as showing greater reactive and proactive aggression, and were less-liked by peers. Findings demonstrate that early childhood CU behaviors and executive function have unique main and interactive effects on both later aggression and lower peer-liking even when taking into account stability in behavior problems over time. By elucidating how CU behaviors and deficits in executive function potentiate each other during early childhood, we can better characterize the emergence of severe and persistent behavior and interpersonal difficulties across development.

Observed fearlessness and positive parenting interact to predict childhood callous-unemotional behaviors among low-income boys

BACKGROUND

Callous-unemotional behaviors identify children at risk for severe and chronic antisocial behavior. Research is needed to establish pathways from temperament and parenting factors that give rise to callous-unemotional behaviors, including interactions of positive versus harsh parenting with child fearlessness.

METHODS

Multimethod data, including parent reports and observations of parent and child behavior, were drawn from a prospective, longitudinal sample of low-income boys (N = 310) with assessments at 18, 24, and 42 months, and at ages 10-12 years old.

RESULTS

Parent-reported callous-unemotional, oppositional, and attention-deficit factors were separable at 42 months. Callous-unemotional behaviors at 42 months predicted callous-unemotional behaviors at ages 10-12, accounting for earlier oppositional and attention-deficit behaviors and self-reported child delinquency at ages 10-12. Observations of fearlessness at 24 months predicted callous-unemotional behaviors at 42 months, but only when parents exhibited low observed levels of positive parenting. The interaction of fearlessness and low positive parenting indirectly predicted callous-unemotional behaviors at 10-12 via callous-unemotional behaviors at 42 months.

CONCLUSIONS

Early fearlessness interacts with low positive parenting to predict early callous-unemotional behaviors, with lasting effects of this person-by-context interaction on callous-unemotional behaviors into late childhood.

Callous-Unemotional Behaviors in Early Childhood: Measurement, Meaning, and the Influence of Parenting

Antisocial behavior is costly and harmful to families, communities, and society. With roots in early childhood, antisocial behavior puts children at risk for poor physical and mental health outcomes across development. Callous-unemotional (CU) traits identify a subgroup of youth with particularly severe and stable antisocial behavior. While much literature has examined CU traits in late childhood and adolescence, researchers are just beginning to elucidate the developmental origins of CU traits. In this article, we review research examining the measurement and correlates of CU behaviors in early childhood, along with evidence that these early behaviors predict later measures of CU traits. We then describe research highlighting the role that parents play in the development of CU behaviors in early childhood. Finally, we outline translational implications and ethical considerations for studying CU behaviors and consider the use of the term CU traits in young children.

A prospective, longitudinal, study of men with borderline personality disorder with and without comorbid antisocial personality disorder

BACKGROUND

Some evidence suggests that the prevalence of Borderline Personality Disorder (BPD) is elevated among male criminal offenders. It is not presently known whether offending, and violent offending, are limited to those presenting comorbid Antisocial Personality Disorder (ASPD) who have a childhood history of conduct problems and whether offending is linked to psychopathic traits.

METHODS

A community sample of 311 males followed from age 6 to 33 years, one third of whom had a criminal charge between ages 18 and 24, completed diagnostic interviews and the Psychopathy Checklist-Revised interview. Information on childhood included parent-reported family characteristics and teacher-rated of hurtful and uncaring behaviours, conduct problems, hyperactivity and inattention, and anxiety at age 6, 10, and 12 years. Health files were obtained as were records of criminal convictions from age 12 to 33.

RESULTS

At age 33, 4% of the men presented BPD and not ASPD, 16% ASPD and not BPD, 8% BPD + ASPD, and 72% neither disorder (ND). Comorbid disorders were common: BPD were distinguished by high levels of anxiety disorders, BPD and BPD + ASPD by depression disorders, and BPD, BPD + ASPD, and ASPD by substance dependence. Official files indicated use of health services by all participants. One-third of participants with BPD and BPD + ASPD acquired a diagnosis of a personality disorder. More than one-third of participants with BPD + ASPD obtained scores indicative of the syndrome of psychopathy. Convictions for violent crimes varied across groups: In adolescence, BPD none, BPD + ASPD 16%, ASPD 16%, and ND 3.6%; from age 18 to 33, BPD 18%, ASPD 19%, BPD + ASPD 52%, and ND 4.4%. Offenders with BPD + ASPD were convicted, on average, for four times more violent crimes than offenders with ASPD and seven times more than ND offenders. In childhood, men with BPD + ASPD and with ASPD had obtained similarly elevated ratings for disruptive behaviours as compared to ND.

CONCLUSION

BPD comorbid with ASPD was associated with violent criminal offending in adolescence and most strongly in adulthood, elevated levels of psychopathic traits, and childhood disruptive behaviour. BPD showed similar characteristics but to a much less degree.

Heritable and Nonheritable Pathways to Early Callous-Unemotional Behaviors

OBJECTIVE

Callous-unemotional behaviors in early childhood signal higher risk for trajectories of antisocial behavior and callous-unemotional traits that culminate in later diagnoses of conduct disorder, antisocial personality disorder, and psychopathy. Studies demonstrate high heritability of callous-unemotional traits, but little research has examined specific heritable pathways to early callous-unemotional behaviors. Studies also indicate that positive parenting protects against the development of callous-unemotional traits, but genetically informed designs have not been used to confirm that these relationships are not the product of gene-environment correlations. In a sample of adopted children and their biological and adoptive mothers, the authors tested novel heritable and nonheritable pathways to preschool callous-unemotional behaviors.

METHOD

In an adoption cohort of 561 families, history of severe antisocial behavior assessed in biological mothers and observations of adoptive mother positive reinforcement at 18 months were examined as predictors of callous-unemotional behaviors at 27 months.

RESULTS

Despite limited or no contact with offspring, biological mother antisocial behavior predicted early callous-unemotional behaviors. Adoptive mother positive reinforcement protected against early callous-unemotional behaviors. High levels of adoptive mother positive reinforcement buffered the effects of heritable risk for callous-unemotional behaviors posed by biological mother antisocial behavior.

CONCLUSIONS

The findings elucidate heritable and nonheritable pathways to early callous-unemotional behaviors. The results provide a specific heritable pathway to callous-unemotional behaviors and compelling evidence that parenting is an important nonheritable factor in the development of callous-unemotional behaviors. The finding that positive reinforcement buffered heritable risk for callous-unemotional behaviors has important translational implications for the prevention of trajectories to serious antisocial behavior.

Toward an Understanding of the Role of the Environment in the Development of Early Callous Behavior

Key to understanding the long-term impact of social inequalities is identifying early behaviors that may signal higher risk for later poor psychosocial outcomes, such as psychopathology. A set of early-emerging characteristics that may signal risk for later externalizing psychopathology is callous-unemotional (CU) behavior. CU behavior predicts severe and chronic trajectories of externalizing behaviors in youth. However, much research on CU behavior has focused on late childhood and adolescence, with little attention paid to early childhood when preventative interventions may be most effective. In this article, we summarize our recent work showing that (a) CU behavior can be identified in early childhood using items from common behavior checklists, (b) CU behavior predicts worse outcomes across early childhood, (c) CU behavior exhibits a nomological network distinct from other early externalizing behaviors, and (d) malleable environmental factors, particularly parenting, may play a role in the development of early CU behaviors. We discuss the challenges of studying contextual contributors to the development of CU behavior in terms of gene-environment correlations and present initial results from work examining CU behavior in an adoption study in which gene-environment correlations are examined in early childhood. We find that parenting is a predictor of early CU behavior even in a sample in which parents are not genetically related to the children.