An exploration of the impact of Callous-Unemotional traits on teachers’ perceptions of student behaviour difficulties and on students’ enjoyment of school

Children and adolescents with callous unemotional (CU) traits are at risk of severe and persistent antisocial behavior. It is commonly assumed that these children are difficult to treat but it has been proposed that they may benefit from being involved in interventions that go beyond typical parent training programs. This systematic review sought to answer two previously unanswered questions: do interventions involving young people reduce levels of CU traits? Do CU traits predict the effectiveness of interventions for antisocial behavior involving young people? Studies were included that adopted an randomized controlled trial, controlled or open trial design and that had examined whether treatment was related to reductions in CU traits or whether CU traits predicted or moderated treatment effectiveness. Treatments used a range of approaches, including behavioral therapy, emotion recognition training, and multimodal interventions. 4/7 studies reported reductions in CU traits following treatment. There was a mixed pattern of findings in 15 studies that examined whether CU traits predicted treatment outcomes following interventions for antisocial behavior. In 7/15 studies, CU traits were associated with worse outcomes, although three of these studies did not provide data on baseline antisocial behavior, making it difficult to evaluate whether children with high CU traits had shown improvements relative to their own behavioral baseline, despite having the worst behavioral outcomes overall. CU traits did not predict outcomes in 7/15 studies. Finally, a single study reported that CU traits predicted an overall increased response to treatment. Overall, the evidence supports the idea that children with CU traits do show reductions in both their CU traits and their antisocial behavior, but typically begin treatment with poorer premorbid functioning and can still end with higher levels of antisocial behavior. However, there is considerable scope to build on the current evidence base.

Children who exhibit callous-unemotional (CU) traits are identified as developing particularly severe forms of externalising behaviours (EB). A number of risk factors have been identified in the development of CU traits, including biological, physiological, and genetic factors. However, prenatal testosterone (PT) remains un-investigated, yet could signal fetal programming of a combination of CU/EB. Using the 2D:4D digit ratio, the current study examined whether CU traits moderated the relationship between PT and EB. Hand scans were obtained from 79 children aged between 5 and 6 years old whose parents completed the parent report ICU (Inventory of Callous Unemotional Traits) and SDQ (Strengths and Difficulties Questionnaire). CU traits were found to moderate the relationship between PT and EB so that children who were exposed to increased PT and were higher in CU traits exhibited more EB. Findings emphasize the importance of recognising that vulnerability for EB that is accompanied by callousness may arise before birth.

Callous-unemotional (CU) traits are associated with severe conduct problems (CP) in youth. Causal theories for CU traits focus on emotion processing deficits that interfere with empathy development. However, though CU traits are consistently associated with deficits in affective empathy (i.e., emotional reactivity), the association between CU traits and cognitive empathy, which requires accurate emotion recognition, is less clear. We hypothesize that past inconsistencies in the associations between CU traits and emotion recognition may be due to interactions with conduct problems (CP) and age. To test this, a sample (N = 258) of school children in the 3rd, 6th, and 8th grades completed a computer task that assessed facial expression recognition, while caregivers and teachers reported on CU traits and CP. Results from hierarchical linear regression analyses indicated significant interactions between CU traits and CP in their associations with overall emotion recognition and with recognition of fearful and sad faces. In each case, CP showed a non-significant negative association with emotion recognition at high levels of CU traits. However, for fear and sadness recognition, CP was positively associated with accuracy at low levels of CU traits. Significant interactions between CU traits and age also emerged for recognition of fear and sadness, such that there were non-significant negative associations between CU traits and recognition accuracy in younger children, but significant positive associations in 8th grade students. These results have multiple implications as they help to clarify past inconsistencies on the association between CU traits and emotion recognition and can aid in the development of more effective interventions to prevent or treat conduct problems in young children.

Which dimension of parenting predicts the change of callous unemotional traits in children with disruptive behavior disorder?

Callous unemotional traits in children with disruptive behavior disorder: Predictors of developmental trajectories and adolescent outcomes

There is evidence that negative parenting positively predicts oppositional defiant disorder (ODD) and conduct disorder (CD) and that children’s callous-unemotional (CU) traits may moderate this association. However, it is largely unknown if CU traits show similar interactive effects with positive parenting for ODD/CD. 208 ethnically diverse (56% Caucasian) 6–9 year-old children with and without attention-deficit/hyperactivity disorder (ADHD) were ascertained using multiple methods and informants for ODD, CD, and CU traits. CU traits, corporal punishment, positive parenting, and each of their interactions with CU traits were unrelated to parent- and teacher-rated ODD. Corporal punishment and CU traits were similarly unrelated to parent- and teacher-rated CD. However, positive parenting inversely predicted parent-reported CD symptoms and it was significantly moderated by CU traits. Positive parenting was negatively associated with CD at low to moderate levels of CU traits, but it was unrelated to CD at high levels of CU traits. Children with elevated levels of CU traits exhibited significantly higher levels of CD symptoms that were largely independent of positive parenting behavior. We discuss these findings within a developmental psychopathology framework to provide further perspectives on reciprocal influences between parenting behavior and CU traits in the development of ODD and CD.

Objective Callous-unemotional (CU) traits are associated with chronic and severe antisocial behavior. Although previous research has found that parents play an important role in the etiology and maintenance of youth CU traits, little research has examined the extent that parents’ own CU traits impact the stability of their children’s CU traits. The present study investigated the moderating role of maternal CU traits on developmental changes in youth CU traits Method A sample of 346 mother-son dyads, in which all youth were justice-involved males (Mage = 15.81; 57.80% Latino, 20.52% White, 18.21% Black, 3.47% other race/ethnicity), across three states (California, Louisiana, and Pennsylvania) completed a semi-structured interview. Results Youth exhibited a decrease in CU traits over 30 months. Mothers’ CU traits moderated this relation, such that high maternal CU traits were associated with a smaller decrease in CU traits than low or average maternal CU traits, both when considering youth CU traits continuously and using a clinically significant cut score. The findings remained for continuous CU traits even after accounting for environmental factors (i.e., maternal warmth, maternal hostility, victimization, and witnessing violence), and these environmental factors did not vary over time. Conclusion The results highlight the importance of maternal influence in understanding how youth CU traits change over time, and have important implications for the use of parenting and family-level interventions among justice-involved youth.

Callous-unemotional (CU) traits are associated with deficits in empathy and emotional responses to others. Specifically, CU traits are consistently correlated with under-reactivity to others’ distress cues. However, it is unknown whether CU traits are also associated with more general deficits in emotional reactivity (e.g., to situations involving threat to the self). Further, the relationship between CU traits and the ability to accurately identify others’ emotions is not well established, and prior work often has not considered possible developmental changes in this relationship. To address these questions, the current study recruited a school-based community sample of children from kindergarten, third, and sixth grades and their parents and teachers. Children completed two cognitive, computer-based tasks to assess reactivity to various types of stimuli and accuracy in facial expression recognition, while their teachers completed ratings of level of CU traits and conduct problems. Overall, the results did not support a direct association between CU traits and emotional reactivity to others’ distress or threat situations. However, the association between CU traits and reactivity was moderated by level of conduct problems, such that at low levels of conduct problems, CU traits were negatively associated with reactivity but there was no significant relationship between CU traits and reactivity at high levels of conduct problems. Additionally, CU traits were negatively associated with emotion recognition accuracy and this relationship was not moderated by child age. However, the relationship between CU traits and emotion recognition was moderated by level of conduct problems and the child’s gender, such that at high levels of conduct problems, CU traits were associated with impairments in emotion recognition and CU traits were associated with deficits in emotion recognition specifically for girls. The implications of these findings for future research and clinical work are discussed.

Callous-unemotional (CU) traits have proved to be a robust and informative construct; identifying a subgroup of children with conduct problems who show more severe and persistent antisocial behaviour. The majority of this work has focused on mid to late childhood and adolescent samples, yet the study of CU traits in early childhood allows identification of developmental pathways to CU traits and may inform the development of preventative interventions. The three empirical studies included in this doctoral thesis use a longitudinal epidemiological sample (Wirral Child Health and Development Study; WCHADS) followed from pregnancy up to age 7 years to examine important questions regarding: 1) the measurement of CU traits in early childhood 2) the contribution of the early parenting relationship to child CU traits; specifically maternal sensitivity to infant distress, with possible mediation by child attachment status, and 3) a candidate sex dependant mechanism for the translation of CU traits into physical aggressive from early to mid-childhood. The first study uses the extensive sample of consecutively recruited first time mothers and the second two studies focus on a subsample stratified by psychosocial risk. The aim of the first study (Chapter 2; n = 775) was to adapt a CU traits measure for use with preschool children. The CU measure derived showed acceptable psychometric properties, factorial invariance by sex and good stability to 5 years. Validity was supported by cross-sectional associations with physical aggression for both boys and girls and incremental prediction to aggression at age 5 in girls only. The second study (Chapter 3; n = 272) examined the longitudinal contribution of maternal parenting behaviours (sensitivity to distress and to non-distress, positive regard, intrusiveness) at 7 months and attachment status at 14 months to child CU traits assessed from age 2.5 to 5 years. Latent variable modelling yielded a single parenting factor which, in line with predictions, significantly predicted reduced CU traits. The effect was mainly explained by sensitivity to infant distress and positive regard towards the infant. These two indicators evidenced a significant interaction, such that the combination of low positive regard and low sensitivity to distress predicted increased child CU traits. Neither attachment security nor disorganization predicted CU traits, so there was no evidence for mediation by attachment status. The final study (Chapter 4; n = 276) examined a hypothesised sex-specific mechanism for the translation of CU traits to aggression via HPA –axis reactivity to stress. Age 5 cortisol reactivity was found to significantly moderate the association between age 5 CU traits and age 7 teacher and mother reported aggression, evidenced by a significant 3-way interaction with sex. There was a significant two-way interaction in boys, such that higher CU traits and lower cortisol reactivity predicted increased physical aggression. Overall, this thesis provides support for the valid measurement of CU traits over the early preschool period. Sensitivity to infant distress, alongside positive regard/warmth, predicted reduced CU traits suggesting that early interventions might also focus on enhancing maternal responsiveness to distress. Findings supported the role of cortisol reactivity to social stress in the translation of CU traits to aggression and critically this was sex specific.

Child maltreatment is associated with disruptions in physiological arousal, emotion regulation, and defensive responses to cues of threat and distress, as well as increased risk for callous unemotional (CU) traits and externalizing behavior. Developmental models of CU traits have focused on biological and genetic risk factors that contribute to hypoarousal and antisocial behavior, but have focused less on environmental influences (Blair, 2004; Daversa, 2010; Hare, Frazell, & Cox, 1978; Krueger, 2000; Shirtcliff et al., 2009; Viding, Fontaine, & McCrory, 2012). The aim of the present investigation was to measure the independent and combined effects of child maltreatment and high CU traits on emotion-modulated startle response in children. Participants consisted of 132 low-income maltreated (n = 60) and nonmaltreated (n = 72) children between 8 and 12 years old who attended a summer camp program. Acoustic startle response (ASR) was elicited in response to a 110-dB 50-ms probe while children viewed a slideshow of pleasant, neutral, and unpleasant IAPS images. Maltreatment status was assessed through examination of Department of Human Services records. CU traits were measured using counselor reports from the Inventory of Callous and Unemotional Traits (Frick, 2004), and conduct problems were measured using counselor and child self-report. We found no significant differences in emotion-modulated startle in the overall sample. However, significant differences in ASR by maltreatment status, maltreatment subtype, and level of CU traits were apparent. Results indicated differential physiological responses for maltreated and nonmaltreated children based on CU traits, including a pathway of hypoarousal for nonmaltreated/high CU children that differed markedly from a more normative physiological trajectory for maltreated/high CU children. Further, we found heightened ASR for emotionally and physically neglected children with high CU and elevated antisocial behavior in these children. Results provide further support for differential trajectories by which experience and biology may influence the development of antisocial behavior in youth and highlight potential avenues for intervention.

Callous-Unemotional Traits as an Intervention Target and Moderator of Parent–Child Interaction Therapy—Emotion Development Treatment for Preschool Depression and Conduct Problems

Although autism and callous-unemotional (CU) traits are distinct conditions, both are associated with difficulties in emotion recognition. However, it is unknown whether the emotion recognition difficulties characteristic of autism and CU traits are driven by comparable underpinning mechanisms. We tested whether cueing to the eyes improved emotion recognition in relation to autistic and CU traits in a heterogeneous sample of children enhanced for social, emotional and behavioural difficulties. Participants were 171 (n=75 male) children aged 10-16 years with and without a diagnosis of autism (n=99 autistic), who completed assessments of emotion recognition with and without cueing to the eyes. Parents completed the assessment of autistic and CU traits. Associations between autistic and CU traits and emotion recognition accuracy were dependent upon gaze cueing. CU traits were associated with an overall decrease in emotion recognition in the uncued condition, but better fear recognition when cued to the eyes. Conversely, autistic traits were associated with decreased emotion recognition in the cued condition only, and no interactions between autistic traits and emotion were found. The differential effect of cueing to the eyes in autistic and CU traits suggests different mechanisms underpin emotion recognition abilities. Results suggest interventions designed to promote looking to the eyes may be beneficial for children with CU traits, but not for children with autistic characteristics. Future developmental studies of autism and CU characteristics are required to better understand how different pathways lead to overlapping socio-cognitive profiles.

Impaired global efficiency in boys with conduct disorder and high callous unemotional traits

High-Quality Foster Care Mitigates Callous-Unemotional Traits Following Early Deprivation in Boys: A Randomized Controlled Trial

Callous-unemotional traits in adolescents moderate neural network associations with empathy