Randomized controlled trial of individualized arousal-biofeedback for children and adolescents with disruptive behavior disorders (DBD)

Disruptive behavior disorders [including conduct disorder (CD) and oppositional defiant disorder (ODD)] are common childhood and adolescent psychiatric conditions often linked to altered arousal. The recommended first-line treatment is multi-modal therapy and includes psychosocial and behavioral interventions. Their modest effect sizes along with clinically and biologically heterogeneous phenotypes emphasize the need for innovative personalized treatment targeting impaired functions such as arousal dysregulation. A total of 37 children aged 8-14 years diagnosed with ODD/CD were randomized to 20 sessions of individualized arousal biofeedback using skin conductance levels (SCL-BF) or active treatment as usual (TAU) including psychoeducation and cognitive-behavioral elements. The primary outcome was the change in parents´ ratings of aggressive behavior measured by the Modified Overt Aggression Scale. Secondary outcome measures were subscales from the Child Behavior Checklist, the Inventory of Callous-Unemotional traits, and the Reactive-Proactive Aggression Questionnaire. The SCL-BF treatment was neither superior nor inferior to the active TAU. Both groups showed reduced aggression after treatment with small effects for the primary outcome and large effects for some secondary outcomes. Importantly, successful learning of SCL self-regulation was related to reduced aggression at post-assessment. Individualized SCL-BF was not inferior to active TAU for any treatment outcome with improvements in aggression. Further, participants were on average able to self-regulate their SCL, and those who best learned self-regulation showed the highest clinical improvement, pointing to specificity of SCL-BF regulation for improving aggression. Further studies with larger samples and improved methods, for example by developing BF for mobile use in ecologically more valid settings are warranted.

Inventory of Callous-Unemotional Traits (ICU) Factor Structure and Measurement Invariance in an Adolescent Multinational Sample

OBJECTIVE

The Inventory of Callous-Unemotional Traits (ICU) is a widely used, comprehensive measure of callous-unemotional (CU) traits. While the ICU total score is used frequently in research, the scale's factor structure remains highly debated. Inconsistencies in past factor structure research appear to be largely due to the use of small non-representative samples and failure to control for method variance (i.e., item wording direction).

METHOD

The current study used a multitrait-multimethod (MTMM) confirmatory factor analysis (CFA) approach that considers both trait and method variance to test the factor structure of a 22-item version of the self-report ICU in a multinational community sample of 4,683 adolescents (ages 11-17).

RESULTS

Results showed that a hierarchical four-factor model (i.e., one overarching CU factor, four latent trait factors) that controlled for method variance (i.e., by allowing residuals from positively worded items to covary) provided the best fit (χ2 = 2797.307, df = 160, RMSEA=.059, CFI=.922, TLI=.888, SRMR=.045).

CONCLUSIONS

After controlling for method variance, the best-fitting factor structure is consistent with how the ICU was developed and corresponds to the four symptoms of Limited Prosocial Emotions (LPE) specifier in the DSM-5 criteria for Conduct Disorder (CD). In addition, measurement invariance of this factor structure across age (i.e., younger versus older adolescents) and sex was supported. As a result, mean differences in ICU total score across age and sex can be interpreted as reflecting true variations in these traits. Further, we documented that boys generally scored higher than girls on the ICU, and this sex difference was larger in later adolescence.

Adolescents High in Callous-Unemotional Traits are Prone to be Bystanders: The Roles of Moral Disengagement, Moral Identity, and Perceived Social Support

Bystanders are the most common role that adolescents play in bullying episodes, they have considerable influence on the formation of the victim's experience and the perpetrator's behavior. Based on the social-cognitive model, the current study examined the mediating role of moral disengagement in the association between callous-unemotional traits and bystander behavior and the moderating roles of moral identity and perceived social support. Participants included 2,286 Chinese adolescents aged 11-16 years (49.3% boys; Mage = 13.46, SDage = 0.93). The study showed callous-unemotional traits were significantly and positively associated with bystander behavior and this relation was partially mediated by moral disengagement. Moral identity moderated the relation between callous-unemotional traits and moral disengagement as well as callous-unemotional traits and bystander behavior. Perceived social support moderated in the direct and indirect associations between callous-unemotional traits and bystander behavior via moral disengagement. The relation between callous-unemotional traits and moral disengagement and the relation between callous-unemotional traits and bystander behavior became weaker for adolescents with high perceived social support. Surprisingly, the relation between moral disengagement and bystander behavior became stronger for adolescents with a high level of perceived social support. The results supported two specific patterns of perceived social support: stress-buffering and reverse stress-buffering. The present study contributes to our understanding of the key mechanisms underlying the association between callous-unemotional traits and adolescents' bystander behavior.

Meta-analysis of the implied distribution of callous-unemotional traits across sampling methods and informant

Callous-unemotional (CU) traits have been measured in a variety of sample-types (e.g., community or forensic) and from the perspective of different informants (e.g., self-report or parent-report) using the inventory of callous-unemotional traits total score (ICU-T). Although the positive association between CU traits and antisocial behavior is uncontroversial, the degree to which sample-types are different from each other has received little attention despite such knowledge being important for generalization and interpretation of research findings. To address this gap in the literature, we estimated the implied distribution of the ICU-T across sample-types, informants, and their interaction using meta-analytic models of sample means and variances. In unconditional models, we found that sample-type significantly moderated mean ICU-T scores but not variance, while informant significantly moderated the variance of ICU-T scores but not means. There was also a significant interaction between sample-type and informant. Mean parent-reported ICU-T scores were significantly lower than self-reported scores in community samples, but not significantly different in samples with elevated levels of antisocial behavior. Implications of our findings include improved research efficiency, the need for different ICU-T norms across informants, and greater understanding of informant biases.

Prefrontal cortex structural and developmental associations with callous-unemotional traits and aggression

Youths with high levels of callous-unemotional (CU) traits and aggression are at an increased risk for developing antisocial behaviours into adulthood. In this population, neurostructural grey matter abnormalities have been observed in the prefrontal cortex. However, the directionality of these associations is inconsistent, prompting some to suggest they may vary across development. Although similar neurodevelopmental patterns have been observed for other disorders featuring emotional and behavioural dysregulation, few studies have tested this hypothesis for CU traits, and particularly not for aggression subtypes. The current study sought to examine grey matter correlates of CU traits and aggression (including its subtypes), and then determine whether these associations varied by age. Fifty-four youths (10-19 years old) who were characterized for CU traits and aggression underwent MRI. Grey matter volume and surface area within the anterior cingulate cortex was positively associated with CU traits. The correlation between CU traits and medial orbitofrontal cortex (mOFC) volume varied significantly as a function of age, as did the correlation between reactive aggression and mOFC surface area. These associations became more positive with age. There were no significant findings for proactive/total aggression. Results are interpreted considering the potential for delayed cortical maturation in youths with high CU traits/aggression.

The association between callous-unemotional traits and suicide ideation among youth: A conditional process analysis

BACKGROUND

The relationship between callous-unemotional (CU) traits (the affective facet of psychopathy and the psychopathy that occurs during childhood and adolescence) and suicide ideation (SI) remains unclear. The mechanisms underlying this association still have a gap in the literature. The aims of this study were to determine whether and how callous-unemotional traits were associated with suicide ideation, and to evaluate the mediating effect of negative affect (includes irritability, depression, and anxiety) and the moderating effect of future orientation on the association.

METHODS

Data were extracted from a longitudinal study involving middle and high school students, with 1,913 students (55.3% girls) aged 11 to 19 years (14.9 ± 1.6 years) completing a self-reported online survey. The conditional process analysis was examined using Mplus 8.3.

RESULTS

We found that callous-unemotional traits positively predicted youths' current suicide ideation, with the observed positive relationship partly mediated by negative affect. However, callous-unemotional traits did not predict the worst-point suicide ideation, which indicated the connection fully mediated by negative affect. Furthermore, future orientation moderated these indirect effects.

LIMITATIONS

Use of self-report measures and cross-sectional design.

CONCLUSIONS

These findings provided evidence for current debates and conflicting conclusions, and set the foundation for future research, as well as implied the important intervention goals for reducing suicide ideation in youth.

The Origins of the Dark—Hyperactivity and Negative Peer Relationships, an Objectively Lower Sleep Efficiency, and a Longer Sleep Onset Latency at Age Five Were Associated with Callous-Unemotional Traits and Low Empathy at Age 14

Background: Within the spectrum of emotional competencies, callous-unemotional traits are socially discouraged, while empathy is considered a socially much more accepted emotional trait. This holds particularly true for adolescents, who are still building up their social and emotional competencies. The aims of the present study were two-fold: First, longitudinally, to identify traits of behavioral problems and objective sleep dimensions at the age of 5 years to predict callous-unemotional traits and empathy at the age of 14 years. Second, cross-sectionally, to associate callous-unemotional traits and empathy with current insomnia, stress, and mental toughness. Methods: Preschoolers at the age of 5 years were contacted nine years later at the age of 14 years. At 5 years, parents rated their children’s behavior (Strength and Difficulties Questionnaire, SDQ); in parallel, children underwent a one-night sleep-EEG assessment. At the age of 14 years, adolescents completed a series of questionnaires covering callous-unemotional traits, insomnia, empathy, stress, and mental toughness. Results: A total of 77 adolescents (38.1% females) took part in the present study. Longitudinally, higher scores for hyperactivity at age 5 significantly predicted higher callous-unemotional traits at age 14. A higher score for negative peer relationships at age 5 significantly predicted lower scores for cognitive empathy at age 14. Further, objective sleep-EEG measures showed that a higher sleep efficiency and a shorter sleep latency was associated with lower scores for callousness. Cross-sectionally, higher scores for callous-unemotional traits were associated with higher insomnia and stress, while lower insomnia was associated with higher empathy. Mental toughness was unrelated to callous-unemotional traits and empathy. Conclusions: It appears that hyperactivity traits and negative peer relationships and more unfavorable objective sleep patterns at 5 years predicted socially discouraged callous-unemotional traits and low empathy during adolescence. Further, cross-sectionally at the age of 14, callous-unemotional traits, subjective poor sleep, and higher stress were associated.

Contributions of Friends' Problem Behaviors to Friendship Quality in a Sample of Children with ADHD

OBJECTIVE

It is often assumed that children with attention-deficit/hyperactivity disorder (ADHD) experience friendship difficulties because of their own problem behaviors. However, friendships are dyadic relationships between two children. This study sought to understand the incremental contributions of friends' problem behaviors to dyadic friendship quality in a clinically diagnosed sample of children with ADHD.

METHOD

One hundred and sixty-five dyads consisting of a target child with ADHD and social impairment (age 6-11; 67% male; 72% white) and a reciprocated, real-life friend were recruited. Parents and teachers rated the ADHD symptom severity, externalizing problems, and callous-unemotional (CU) traits of target children and friends. Friendship quality in the dyad was measured with: (a) questionnaires independently completed by target children, their parents, their friends, and the parents of their friends; and (b) observations of child-friend interactions.

RESULTS

The severity of ADHD symptoms and externalizing problems (but not CU traits) in target children was associated with more negative friendship quality reported on questionnaires. Adjusting for the corresponding problem behavior in target children, each type of friends' problem behaviors incrementally predicted less positive friendship quality (on questionnaires). Friends' ADHD symptoms and CU traits also incrementally predicted more negative friendship quality (on questionnaires and observations).

CONCLUSIONS

Considering problem behaviors in friends of children with ADHD (in addition to those in children with ADHD) may be important for identifying dyads at risk for lower quality friendships. These findings could possibly lead to new directions when designing and evaluating treatments targeting the friendship problems of children with ADHD.

Rigorous idiography: Exploring subjective and idiographic data with rigorous methods-The method of derangements

Psychological research often seeks general rules applying across individuals, an aim that is in tension with examining that which is unique to any individual. There are general statistical regularities across individuals' subjective self-report which enable much psychology and psychotherapy research to combine data from self-report questionnaire responses with statistical and psychometric methods to create a fundamental part of Cronbach and Meehl's foundational nomological networks of validity. However, these methods only apply when most participants answer the same questions on measures creating nomothetic data and this has led to a neglect of idiographic data. This paper reviews a method of analysis of idiographic data, of "rigorous idiography": the method of derangements. This is a remarkably simple statistical test of whether purely idiographic data convey reliable information. We show how the method appeared to become stuck in a bibliometric backwater but we expand on its potential for research and practise and hope it will be taken up and used correctly and more widely.

Multi-Informant Ratings of Childhood Limited Prosocial Emotions: Mother, Father, and Teacher Perspectives

OBJECTIVE

Modest agreement between mothers', fathers', and teachers' reports of child psychopathology can cause diagnostic ambiguity. Despite this, there is little research on informant perspectives of youth's limited prosocial emotions (LPEs). We examined the relationship between mother-, father-, and teacher-reported LPE in a clinical sample of elementary school-aged children.

METHOD

The sample included 207 primarily Caucasian (n = 175, 84.5%) children (136 boys; 65.7%) aged 6-13 years (M = 8.35, SD = 2.04) referred to an outpatient child diagnostic clinic focused on externalizing problems. We report the percentage of youth meeting LPE criteria as a function of informant perspective(s). Utilizing standard scores, we report distributions of informant dyads in agreement/disagreement regarding child LPE, followed up by polynomial regressions to further interrogate the relationship between mother-, father-, and teacher-reported LPE as it relates to conduct problems (CPs).

RESULTS

The prevalence of child LPE was approximately twice as large when compared to those reported in community samples; mothers and fathers generally agreed on their child's LPE symptoms (55% agreement). Higher-order nonlinear interactions between mothers and fathers, as well as parents and teachers, emerged; discrepancies between informants, characterized by low levels of LPE reported by the child's mother, were predictive of youth at the highest risk for CPs.

CONCLUSIONS

Our findings emphasize the clinical utility of gathering multiple reports of LPE when serious CPs are suspected. It may be beneficial for clinicians to give significant consideration to teacher reported LPE when interpreting multiple-informant reports of LPE.

CONSISTENCY AND VALIDITY OF THE INVENTORY OF CALLOUS- UNEMOTIONAL TRAITS IN A MULTI-CENTRIC COMMUNITY SAMPLE

The purpose of this research was to validate the Inventory of Callous Unemotional Traits in a multi-centric community sample of Colombian children and adolescents aged between 9 and 18 years. An adapted version to the Colombian Spanish was applied to 903 school students without significant medical background (neurotypical behavior), and 118 with a clinical history of internalizing or externalizing conditions. A group of specialized judges approved the content validity of the instrument in terms of relevance and intelligibility, but concept factorial validity was low for the uncaring and callousness factors. Exploratory factor analysis confirmed the existence of three dimensions (uncaring, unemotional, and callousness), but only 17 out of 24 items demonstrated adequate psychometric statistics. The consistency for the 17-item Colombian adaptation was acceptable (α = .78). Goodness-of-fit calculated through confirmatory analysis was satisfactory for a bifactor structure (model C). Neurotypical participants showed lower total scores in comparison to the other groups. Participants with internalizing conditions had higher unemotional traits, while those with externalizing behaviors more commonly presented uncaring behaviors. This study is important for psychopathy research in Colombia as provides a validated adaption of the most used instrument to assess callous-unemotional traits in children and adolescents.

California Critical Thinking Disposition Inventory: Reliability Generalization Meta-Analysis

The aims of this reliability generalization study were to provide the overall alpha values of the California critical thinking disposition inventory (CCTDI) total score and subscales scores and investigate the characteristics of the studies that may be associated with the variability in the reliability values of the CCTDI total score and subscales scores. This study was carried out with 98 alpha values from 87 unique studies for total CCTDI scores. In the random effects model, total CCTDI was found to be reliable across samples with alpha value of 0.83. Also, the general alpha coefficients were 0.65, 0.56, 0.64, 0.66, 0.74, 0.72, and 0.61 for TS-scale, OM-scale, A-scale, S-scale, SC-scale, I-scale, and M-scale, respectively. Examination of study characteristics indicated that sample type was a significant predictor for alpha value of total CCTDI and all subscales. Samples with university students reported larger Cronbach’s alpha estimates for total CCTDI and all subscales. Also, while language was found to moderate the general alpha coefficient of total CCTDI, OM-scale, A-scale, S-scale, and I-scale, it was not a significant moderator on the general alpha value of TS-scale, SC-scale, and M-scale. Total CCTDI and all subscales showed higher Cronbach’s alpha values for the English-language administrations. Besides, country of the study was a significant moderator on the general alpha coefficient of total CCTDI, S-scale, and I-scale. However, subgroup of discipline was not a significant moderator on the general alpha coefficient of total CCTDI and its subscales. The mean of the test scores significantly explained %5 of the variance of alpha values of the total CCTDI. SD of the test scores significantly explained %10, %55, and %54 of the variance of alpha values of the total CCTDI, A-scale, and S-scale, respectively. It was found that gender and ethnicity significantly moderated the alpha values for M-scale.

Gray matter asymmetry in the orbitofrontal cortex in relation to psychopathic traits in adolescents

BACKGROUND

Structural abnormalities in the orbitofrontal cortex (OFC) of incarcerated psychopaths have been well documented. However, the neural correlates of psychopathic traits in younger and nonclinical samples remain poorly understood.

AIM

The present study aimed to examine the structural brain asymmetry in the OFC in relation to dimensions of psychopathic traits in adolescents from the community.

METHOD

In 29 youths from the community, childhood psychopathic traits including narcissism, impulsivity, and callous-unemotional traits were assessed when they were 7- to 10 years old (Time 1), and their gray matter (GM) volumes were measured using structural Magnetic Resonance Imaging when they were 10- to 14 years old (Time 2).

RESULTS

After controlling for age, sex, IQ, pubertal stage, and whole-brain volumes, callous-unemotional traits were associated with right-left asymmetry in the medial OFC (mOFC), that is, smaller right mOFC GM as compared to the left. Impulsivity was associated with left-right asymmetry in the mOFC, that is, smaller left mOFC than the right. Narcissism was not associated with any GM asymmetry measure. No significant association was found for the lateral OFC, amygdala, caudate and putamen.

CONCLUSION

The present findings provide further support that dimensions of psychopathic traits may have distinct neurobiological correlates.

Factorial Structure and Nomological Network of the Inventory of Callous-Unemotional Traits Accounting for Item Keying Variance

The factorial structure of the Inventory of Callous Unemotional Traits (ICU) is currently under dispute. The present study aims to test the factorial structure of a Greek adaptation of the ICU by considering item keying variance and examining alternative theoretical and empirically derived models. Additionally, it aims to investigate the nomological network of the ICU subscales, after controlling for item keying variance. The sample consisted of 1536 Greek-Cypriot adolescents, who completed a battery of questionnaires, including the ICU. Results showed that the consideration of item keying variance improved the overall fit of all the examined models and led to significant changes in the predictive validity of the subscales, while method factors presented distinct patterns of associations with external variables. Overall, results suggest that ICU is contaminated by item keying variance, which can be filtered out to provide clinically useful insight into the factorial structure of the ICU.

Assessing Callous-Unemotional Traits in Chinese Detained Boys: Factor Structure and Construct Validity of the Inventory of Callous-Unemotional Traits

The Inventory of Callous-Unemotional Traits (ICU) was designed to evaluate multiple facets of Callous-Unemotional (CU) traits in youths. However, no study has examined the factor structure and psychometrical properties of the ICU in Chinese detained juveniles. The current study assesses the factor structure, internal consistency and convergent validity of the ICU in 613 Chinese detained boys. Confirmatory factor analysis results indicated that the original three-factor model with 24 items showed an unacceptable fit to the data, however, the 11-item shortened version of the ICU (ICU-11) with callousness and uncaring dimensions showed the best fit. Moreover, the ICU-11 total score and factor scores had good and acceptable internal consistencies. The convergent and criterion validity of the ICU-11 was demonstrated by comparable and significant associations in the expected direction with relevant external criteria (e.g., psychopathy, aggression, and empathy). In conclusion, present findings indicated that the ICU-11 is a reliable and efficient instrument to replace the original ICU when assessing CU traits in the Chinese male detained juvenile sample.

Further Validation of the Inventory of Callous–Unemotional Traits in Chinese Children: Cross-Informants Invariance and Longitudinal Invariance

The present study examined the factor structure and measurement invariance of the shortened versions of the Inventory of Callous–Unemotional Traits (ICU) with data from multiple informants. Five short versions of the ICU proposed in previous studies were tested and compared through confirmatory factor analysis. The measurement invariance across different informants (i.e., self-report, parent-report, and teacher-report) and longitudinal measurement invariance for the resulting best-fitting model were tested thoroughly. Results indicated that a shortened form that consists of 11 items (ICU-11) to assess callousness and uncaring factors had excellent overall fit. Moreover, the ICU-11 was invariant across informant and occasions. However, the ICU-11 was not without limitations; the internal consistency α for the uncaring factor with self-report scores was marginal. In conclusion, our findings suggest that the ICU-11 was an excellent fit for our data and displayed measurement invariance across informants and over time. The ICU-11 may be a promising assessment tool that could be used in research to assess callous–uncaring traits in Chinese children.