Effects Of Callous-unemotional Traits Research Articles

The Moderating Role of Maternal Praise and Positivity in the Association Between Callous-Unemotional (CU) Traits and Later Aggression: A Prospective Study in Preschool Children in Colombia

Our previous findings in the UK and Colombia show that CU traits predict later aggression specifically among children who are already aggressive. We hypothesised that this effect would be reduced in the presence of maternal praise and positivity. In a sample of 220 mothers and children from Colombia, mother–child interactions were coded for maternal praise and positivity, and mothers reported on children’s CU traits at age 3.5 and aggression at ages 3.5 and 5 years. The results show three-way interactions between CU traits, child aggression and observed parenting at age 3.5 years in the prediction of later child aggression, and two-way interactions indicating a protective effect of positive parenting in the high aggressive children. Based on our finding, it is plausible that positive parenting may modify the effect of CU traits in the highly vulnerable group of children who are already aggressive in early childhood.

Investigating Emotional Body Posture Recognition in Adolescents with Conduct Disorder Using Eye-Tracking Methods

Adolescents with Conduct Disorder (CD) show deficits in recognizing facial expressions of emotion, but it is not known whether these difficulties extend to other social cues, such as emotional body postures. Moreover, in the absence of eye-tracking data, it is not known whether such deficits, if present, are due to a failure to attend to emotionally informative regions of the body. Male and female adolescents with CD and varying levels of callous-unemotional (CU) traits (n = 45) and age- and sex-matched typically-developing controls (n = 51) categorized static and dynamic emotional body postures. The emotion categorization task was paired with eye-tracking methods to investigate relationships between fixation behavior and recognition performance. Having CD was associated with impaired recognition of static and dynamic body postures and atypical fixation behavior. Furthermore, males were less likely to fixate emotionally-informative regions of the body than females. While we found no effects of CU traits on body posture recognition, the effects of CU traits on fixation behavior varied according to CD status and sex, with CD males with lower levels of CU traits showing the most atypical fixation behavior. Critically, atypical fixation behavior did not explain the body posture recognition deficits observed in CD. Our findings suggest that CD-related impairments in recognition of body postures of emotion are not due to attentional issues. Training programmes designed to ameliorate the emotion recognition difficulties associated with CD may need to incorporate a body posture component.

Antisocial behaviour and teacher-student relationship quality: The role of emotion-related abilities and callous-unemotional traits.

Childhood antisocial behaviour has been associated with poorer teacher-student relationship (TSR) quality. It is also well-established that youth with antisocial behaviour have a range of emotion-related deficits, yet the impact of these students' emotion-related abilities on the TSR is not understood. Furthermore, the addition of the Limited Prosocial Emotions Specifier in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) indicates that understanding the role of callous-unemotional (CU) traits for youth with antisocial behaviour problems is of particular importance. The aim of this study was to investigate the association between antisocial behaviour difficulties and the TSR by examining the influence of emotion-related abilities and CU traits. Twelve teachers from 10 primary schools provided anonymized information on 108 children aged 6-11years. Antisocial behaviour was associated with higher teacher-student conflict (but not closeness) as well as higher emotion lability/negativity and lower emotion understanding/empathy. Emotion lability/negativity was associated with higher teacher-student conflict (but not closeness), and emotion understanding/empathy was associated with lower teacher-student conflict and higher closeness. CU traits were associated with higher teacher-student conflict and lower teacher-student closeness (controlling for antisocial behaviour more broadly). We found no evidence of a moderating effect of CU traits or emotion-related abilities on the association between antisocial behaviour and TSR quality. Interventions for behaviour difficulties should consider teacher-student relationships in the classroom. Strategies which aim to improve teacher-student closeness as well as reduce teacher-student conflict may be of particular value to students with high CU traits.

Effects of Substance Misuse and Family History of Substance Use Disorder on Delay Discounting in Adolescents and Young Adults with Attention-Deficit/Hyperactivity Disorder

Background: Attention-deficit/hyperactivity disorder (ADHD) and substance use disorder (SUD) often co-occur. Both disorders are characterized by impulsive choice. However, little is known about the effects of substance misuse (SM) and family history of SUD (FH) on impulsive choice in ADHD-SUD comorbidity. Impulsive choice is also linked to callous-unemotional (CU) traits, which are suggested to play a role in ADHD-SUD comorbidity. Our aim was to examine the effects of (1) FH and (2) SM on impulsive choice, while exploring the role of CU traits. Methods: Impulsive choice was assessed with the delay discounting (DD) task. We compared task performance across (1) ADHD patients and controls with or without FH of SUD (ADHD FH+: n = 86; ADHD FH−: n = 63; control FH+: n = 49; control FH−: n = 72; mean age of the whole sample [n = 270]: 16.39, SD: 3.43) and (2) family history-matched ADHD groups with and without SM and controls (ADHD + SM: n = 62; ADHD-only: n = 62; controls: n = 62; mean age of the whole sample [n = 186]: 18.01, SD: 2.71). Effects of CU traits were explored by adding this as a covariate in all analyses. Results: (1) There was no main effect of FH on DD. (2) We found increased DD in ADHD + SM compared to ADHD-only and no difference between ADHD-only and controls. Finally, increased DD was associated with increased callous traits only in ADHD FH+ and control FH+. Conclusions: In adolescents and young adults with ADHD, high impulsive choice might only be present in those with comorbid SM and in an FH+ subgroup with high callous traits. This suggests that impulsive choice in ADHD might result from (1) effects of SM and (2) a combined effect of SUD vulnerability and high callousness. Future studies should investigate efficacy of early interventions, targeting CU traits.

The effects of callous-unemotional traits and aggression subtypes on amygdala activity in response to negative faces.

Brain imaging studies have shown altered amygdala activity during emotion processing in children and adolescents with oppositional defiant disorder (ODD) and conduct disorder (CD) compared to typically developing children and adolescents (TD). Here we aimed to assess whether aggression-related subtypes (reactive and proactive aggression) and callous-unemotional (CU) traits predicted variation in amygdala activity and skin conductance (SC) response during emotion processing. We included 177 participants (n = 108 cases with disruptive behaviour and/or ODD/CD and n = 69 TD), aged 8-18 years, across nine sites in Europe, as part of the EU Aggressotype and MATRICS projects. All participants performed an emotional face-matching functional magnetic resonance imaging task. Differences between cases and TD in affective processing, as well as specificity of activation patterns for aggression subtypes and CU traits, were assessed. Simultaneous SC recordings were acquired in a subsample (n = 63). Cases compared to TDs showed higher amygdala activity in response to negative faces (fearful and angry) v. shapes. Subtyping cases according to aggression-related subtypes did not significantly influence on amygdala activity; while stratification based on CU traits was more sensitive and revealed decreased amygdala activity in the high CU group. SC responses were significantly lower in cases and negatively correlated with CU traits, reactive and proactive aggression. Our results showed differences in amygdala activity and SC responses to emotional faces between cases with ODD/CD and TD, while CU traits moderate both central (amygdala) and peripheral (SC) responses. Our insights regarding subtypes and trait-specific aggression could be used for improved diagnostics and personalized treatment.

Childhood Maltreatment Is Associated With Aggression Among Male Juvenile Delinquents in China: The Mediating Effects of Callous-Unemotional Traits and Self-Control

Background: Aggression is an important risk factor for delinquency and crime in adolescents. Previous studies have indicated that childhood maltreatment plays an important role in the development of aggression. However, whether the effect could be mediated by other factors is still unknown. Evidence suggests that callous-unemotional (CU) traits and self-control may be candidate mediators in the relationship between childhood maltreatment and aggression.Methods: A total of 585 male juvenile delinquents from China were recruited for the present study. We measured self-reported childhood maltreatment, CU traits, self-control, and aggression with the short form of the Childhood Trauma Questionnaire (CTQ-SF), the Inventory of Callous-Unemotional Traits (ICU), the Self-Control Scale (SCS), and the Aggression Questionnaire (AQ), respectively. Furthermore, we constructed multiple mediation models to investigate the mediating effects of CU traits and self-control on the relationship between childhood maltreatment and aggression. Childhood maltreatment and aggression were entered into the model as the independent and dependent variables, respectively, and CU traits and self-control were treated as the mediating variables. In addition, the moderating role of self-control in the relationship between childhood maltreatment and aggression was tested by constructing a moderation model.Results: Correlation analysis showed significant positive correlations among childhood maltreatment, CU traits, and aggression (all r values > 0.31, P values < 0.01), and self-control was negatively correlated with these three factors (all r values < −0.32, P values < 0.01). Mediation analyses showed that the relationship between childhood maltreatment and aggression was completely and sequentially mediated by the factors of CU traits and self-control (indirect effect = 0.31, P < 0.001). In addition, the relationship between childhood maltreatment and aggression could also be completely mediated by CU traits (indirect effect = 0.24, P < 0.001) and self-control (indirect effect = 0.26, P < 0.001) separately.Conclusion: Our results indicate that, in a sample of male juvenile delinquents in China, the relationship between childhood maltreatment and adolescent aggression was found to be mediated by CU traits and self-control, which may shed light on the development of aggression among male juvenile delinquents.

Callous-Unemotional Traits and Antisocial Behavior in South Korean Children: Links with Academic Motivation, School Engagement, and Teachers\u2019 Use of Reward and Discipline

Callous-unemotional (CU) traits have been associated with atypical responses to reward and punishment cues, with evidence suggesting that such traits may shape caregiver use of reward and punishment practices over time. To date, research has predominantly focused on parental rewards and discipline, with far less attention paid to teacher behavior management strategies. The first aim of the current study was to investigate the potential moderating effect of CU traits on the relationship between teacher classroom management strategies (rewards and discipline) and two important school-related outcomes: student engagement and academic motivation. The second aim was to examine whether CU traits were related to teachers’ use of discipline and reward strategies over time. Children attending South Korean primary schools (N = 218; aged 10–12 years; 52% boys) reported on CU traits, antisocial behavior, teacher classroom management strategies, school engagement and academic motivation at two time points (the beginning and end of a single academic year). First, harsh teacher discipline predicted lower school engagement, but only for children low in CU traits. Second, cross-lagged longitudinal models showed that CU traits predicted decreased use of teacher rewards, over and above associations with antisocial behavior. CU traits were not related to harsh discipline cross-sectionally or longitudinally in models that accounted for antisocial behavior. Findings show that CU traits are related to reduced sensitivity to teacher discipline, suggesting that teachers may need additional support to implement both discipline and reward-based strategies with children high in these traits.

Internet-Delivered Parent Training for Preschoolers with Conduct Problems: Do Callous-Unemotional Traits Moderate Efficacy and Engagement?

Recent efforts to improve access to evidence-based parent training programs using online delivery have largely neglected findings that young children with callous-unemotional (CU)-type conduct problems receive less benefit from parent training than children with conduct problems alone. The current study aimed to examine the moderating effect of child CU traits on efficacy and engagement outcomes associated with Internet-delivered Parent-Child Interaction Therapy (iPCIT) versus standard, clinic-based PCIT. Forty families (57.6% non-Hispanic Caucasian) with a 3-5year-old (M = 3.95years, SD = 0.9; 83.5% boys) child with a disruptive behavior disorder were randomized to either iPCIT or clinic-based PCIT. Families participated in four assessments across time; child conduct problems, global functioning and treatment responder status, and parent-rated treatment satisfaction were measured. Analyses revealed that the negative influence of CU traits on functional gains was not uniform across treatment formats. Specifically, the detrimental effect of CU traits on functional gains was significantly more pronounced among children treated with iPCIT than clinic-based PCIT. CU traits also predicted lower parental treatment satisfaction across delivery formats, but this effect was more pronounced among iPCIT parents. In contrast, CU traits did not moderate differential effects across iPCIT and clinic-based PCIT for conduct problem severity or treatment responsestatus. Findings suggest that iPCIT is a promising treatment option for early conduct problems, particularly when access-to-care barriers exist, but that further research is needed to determine whether strategic adaptations to online programs can more optimally address the distinct needs of children with clinically significant CU traits.

The Role of Empathy as a Mediator Between Callous-Unemotional Traits and Bullying

Objectives: The present study examines the role of empathy as a mediator between callous-unemotional traits and bullying among students. Methods: The present descriptive correlational study was conducted on 250 students selected from the 14th district of Tehran, Iran through cluster sampling in the academic year of 2017 - 2018. The subjects completed the inventory of callous-unemotional traits (ICUT), the empathy scale and the Illinois bully scale (IBS). The data collected were analyzed in SPSS-23 and AMOS-23 using statistical correlations and structural equation modeling. Results: The present results suggested that the effect of callous-unemotional Traits on empathy is negative and significant (-0.44) and on bullying is positive and significant (0.48). Empathy also exerted a positive and significant effect on bullying (0.30). Callous-unemotional traits indirectly affected bullying with empathy as the mediator. Conclusions: Authorities of schools and organizations are recommended to teach empathy to students to reduce the incidence of student bullying.

Daily oxytocin patterns in relation to psychopathy and childhood trauma in residential youth

Inconsistent findings have been found on the relation between oxytocin levels and psychopathy or callous-unemotional (CU) traits in humans, potentially because the role of trauma in oxytocin secretion and the distinction between primary and secondary psychopathy have been overlooked so far. Primary psychopathy has a stronger biological background, whereas secondary psychopathy mainly develops due to environmental adversity, such as childhood trauma. This study investigated the interaction effects of CU traits and childhood trauma on daily salivary oxytocin levels in 57 males living in residential youth care facilities. Participants provided six saliva samples (morning, afternoon, and evening for two consecutive days) and completed self-report questionnaires on CU traits and childhood trauma. A mean daily oxytocin and an oxytocin pattern across the day were examined. A significant interaction between CU traits and one trauma category (emotional neglect) on mean daily oxytocin was observed, demonstrating that subjects with high CU traits and low levels of emotional neglect (primary psychopathy) exhibited lower daily oxytocin secretion compared to subjects with high CU traits and high levels of emotional neglect (secondary psychopathy). There were no significant interactions with the other trauma types or in daily oxytocin patterns. Our findings provided a first insight into the potentially distinct oxytocin concentrations in primary and secondary psychopathy, suggesting that primary psychopathy might be linked to lower daily oxytocin output. Future longitudinal studies are required to unravel the developmental patterns of oxytocin secretion and determine whether lower oxytocin output might be a biomarker of primary psychopathy.

The Relation Between Callous-Unemotional Traits, Psychosocial Maturity, and Delinquent Behavior Among Justice-Involved Youth.

Callous-unemotional (CU) traits are a risk factor for severe and persistent patterns of juvenile delinquency. Given the influence of CU trait assessments in justice-system settings, it is important to determine whether the predictive utility of CU traits is conditional on the absence of protective psychosocial factors. Employing a sample of justice-involved male youth (N=1,216, Mage =15.29), this study examined whether psychosocial maturity (PSM) outweighs or attenuates the effect of CU traits on delinquency. Results indicated that youth with high CU traits or low PSM offended more during the year following their first arrest. Additionally, PSM moderated the relation between CU traits and offending, such that higher PSM was associated with less offending but only among low CU youth.

Risky Sex, Drugs, Sensation Seeking, and Callous Unemotional Traits in Justice-Involved Male Adolescents

The current study examined whether callous-unemotional (CU) traits predicted risky sexual behavior (i.e., unprotected sex, casual sex) and whether substance use and sensation seeking mediated this relationship over 24 months in justice-involved young men. Participants (N = 1,216) were an ethnically and racially diverse sample (46.3% White Latino, 38% Black, 15.7% White non-Latino) of first-time offending male adolescents (ages 13–17 years) from 3 U.S. cities. Participants completed 5 self-reported interviews at 6-month intervals over 2 years. Bootstrapped mediation analyses were conducted to test direct effects of CU traits on risky sexual behaviors, as well as indirect effects through substance use and sensation seeking. CU traits at baseline were positively associated with risky sexual behavior 18–24 months later. CU traits were also associated with the hypothesized mediators, sensation seeking and substance use, measured 6–12 months after baseline. CU traits exerted direct effects on later unprotected sex and casual sex, as well as indirect effects through substance use but not sensation seeking. These effects were largely unchanged when accounting for the youth’s level of self-reported delinquency. These findings demonstrate that CU traits predict later risky sexual outcomes, and this is at least partly explained by substance use. Further, the findings highlight the importance of CU traits for several outcomes that are of significant public health concern among justice-involved adolescents, namely, risky sexual behavior and substance use.

Callous-unemotional traits predict self-reported offending in adolescent boys: The mediating role of delinquent peers and the moderating role of parenting practices.

Research has only recently begun to examine how callous-unemotional (CU) traits interact with contextual factors to predict delinquent behavior. The current study attempts to explain the well-established link between CU traits and offending by testing the potential mediating and moderating roles of 2 critical contextual factors: peer delinquency and the quality of the parent-adolescent relationship among a sample of 1,216 male juvenile offenders. Youth in the study were interviewed once every 6 months and in the current analyses, CU traits measured at baseline, parenting and delinquent peer association measured during the 6-month interview, and offending measured at the 1-year interview were utilized in path analysis. The findings suggested that the effect of CU traits was partially mediated by delinquent peer association. Additionally, it was found that when both parental warmth and supervision were high, this indirect effect through delinquent peer association was no longer significant. The findings highlight the importance of specific aspects of parenting in reducing delinquent peer influence, particularly among youth with high levels of CU traits. (PsycINFO Database Record

Callous-unemotional traits and moral disengagement as antecedents to the peer influence effect: moderation or mediation?

ABSTRACTThe purpose of this study was to determine whether callous-unemotional (CU) traits and moral disengagement (MD) serve as antecedents to the peer influence effect. There were two hypotheses tested in this study: (1) Moral disengagement will moderate the effect of CU traits on peer influence, and (2) Moral disengagement will mediate the effect of CU traits on peer influence. These two hypotheses were tested in a sample of 1354 male and female delinquents from the Pathways to Desistance study, using four waves of data, with six months between waves. Contrary to Hypothesis 1, regression and path analyses failed to support a moderating effect for moral disengagement with respect to the CU → peer influence or CU → peer/participant delinquency relationships. Consistent with Hypothesis 2, however, path analysis revealed that moral disengagement successfully mediated the CU → peer influence relationship. In further support of Hypothesis 2, a control pathway running from CU to moral disengagement to peer selection failed to achieve significance. These results suggest that the effect of CU traits on delinquency may be mediated by variables like moral disengagement and peer delinquency, a position consistent with the moral model of criminal lifestyle development.

Psychopathic traits mediate the association of serotonin transporter genotype and child externalizing behavior.

Although the promoter polymorphism of the serotonin transporter (5-HTTLPR) gene is associated with externalizing behavior, its mediating pathways are unknown. Given their sensitivity to serotonin neurotransmission and unique association with attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD), we tested callous-unemotional (CU) traits and narcissism as separate mediators of the association of 5-HTTLPR with ADHD and ODD. We evaluated 209 5-9 year-old children with and without ADHD at baseline; approximately 2 years later (i.e., Wave 2), parents and teachers separately rated ADHD and ODD symptoms and youth self-reported antisocial behavior. Controlling for race-ethnicity and baseline ADHD/ODD, narcissism uniquely mediated predictions of multi-informant rated Wave 2 ADHD and ODD from variation in 5-HTTLPR; CU traits mediated predictions of Wave 2 ADHD from variations in 5-HTTLPR, but did not mediate the associations of 5-HTTLPR with ODD or youth self-reported antisocial behavior. Specifically, the number of 5-HTTLPR long alleles positively predicted CU traits and narcissism; narcissism was positively associated with Wave 2 ADHD and ODD symptoms, whereas CU traits were positively associated with Wave 2 ADHD. Child sex also moderated indirect effects of CU traits and narcissism, such that narcissism mediated predictions of ADHD/ODD in girls but not boys. Psychopathic traits may represent a relevant pathway underlying predictions of prospective change in ADHD and ODD from 5-HTTLPR, particularly in girls. We consider the role of psychopathic traits as a potential intermediate phenotype in genetically sensitive studies of child psychopathology. Aggr. Behav. 42:455-470, 2016. © 2016 Wiley Periodicals, Inc.

Impulse Control and Callous-Unemotional Traits Distinguish Patterns of Delinquency and Substance Use in Justice Involved Adolescents: Examining the Moderating Role of Neighborhood Context.

Both callous-unemotional (CU) traits and impulse control are known risk factors associated with delinquency and substance use. However, research is limited in how contextual factors such as neighborhood conditions influence the associations between these two dispositional factors and these two externalizing behaviors. The current study utilized latent class analysis (LCA) to identify unique classes of delinquency and substance use within an ethnically diverse sample (n = 1216) of justice-involved adolescents (ages 13 to 17) from three different sites. Neighborhood disorder, CU traits, and impulse control were all independently associated with membership in classes with more extensive histories of delinquency and substance use. The effects of CU traits and impulse control in distinguishing delinquent classes was invariant across levels of neighborhood disorder, whereas neighborhood disorder moderated the association between impulse control and substance use. Specifically, the probability of being in more severe substance using classes for those low in impulse control was stronger in neighborhoods with fewer indicators of social and physical disorder.

Does Gender Moderate the Relationship between Callous-Unemotional Traits and Physical Aggression?

The study investigates the interaction effect of callous-unemotional (CU) traits and gender on physical aggression among Nigerian adolescents. Two hundred and ninety five (295) senior secondary school students who were between 14-16 years of age participated in the study. These participants included boys (152) and girls (143). They were selected from a public senior secondary school in Anambra a South Eastern State of Nigeria and all the participants were of Igbo ethnic group. The raw data for Callous-unemotional traits and Physical Aggression were collected using Inventory of Callous-Unemotional Traits (ICU) by Frick (2004) and Aggression Scale by Orpinas and Frankowski (2001) respectively. The data were analyzed using Pearson correlation, and conditional process analysis (model number 1; Hayes, 2013). The results showed that gender correlated significantly with uncaring and physical aggression but did not correlate significantly with CU and callousness. The results further showed that gender, CU traits, uncaring and callousness subscales significantly predicted physical aggression. Gender also moderated the effect of CU traits and uncaring on physical aggression, but did not moderate the effect of callousness on physical aggression. The discussion focused on the ways of helping individuals with high level of CU traits to reduce aggression, also the limitations of the study, suggestions for further studies and the implications of the finding were highlighted.

The effects of callous-unemotional traits and narcissistic personality on delinquency of adolescents on probation across gender

본 연구에서는 보호관찰대상 청소년을 대상으로 냉담-무정서 특질과 자기애적 성격성향이 이들의 비행에 미치는 영향을 확인하고자 하였다. 보호관찰소에 입소 중인 295명이 연구에 참여하였으며, 한국판 냉담-무정서 특질 척도, 자기애적 성격성향 척도, 청소년 행동평가 척도- 자기보고용을 시행하였다. 분석 결과, 냉담-무정서 특질, 자기애적 성격성향, 비행의 하위요인 에서 성별에 따른 차이가 나타났으며, 여자 청소년의 비행수준이 더 높음을 확인하였다. 성별에 따른 냉담-무정서 특질, 자기애적 성격성향, 비행간의 상관관계를 살펴본 결과, 여자 청소년의 경우 냉담성이 비행과 유의미한 상관을 보였고, 남자 청소년의 경우 감정표현결여가 비행과 유의미한 상관을 보였다. 또한 성별에 따라 냉담-무정서 특질의 하위요인과 자기애적성격성향이 비행에 미치는 영향을 확인한 결과, 냉담성은 여자 청소년의 비행을 잘 설명하였고 감정표현결여는 남자 청소년의 비행을 잘 설명하였으며, 자기애적 성격성향은 비행에 대해 냉담-무정서 특질의 설명력을 넘어서는 추가적인 설명력을 지니는 것으로 나타났다. 본 연구의 시사점 및 제한점에 대해 논의하였다.

Cognitive and affective empathy in children with conduct problems: Additive and interactive effects of callous–unemotional traits and autism spectrum disorders symptoms

Callous–unemotional (CU) traits and autism spectrum disorders (ASD) symptoms are characterized by problems in empathy; however, these behavioral features are rarely examined together in children with conduct problems. This study investigated additive and interactive effects of CU traits and ASD symptoms in relation to cognitive and affective empathy in a non-ASD clinic-referred sample. Participants were 134 children aged 3 to 9 years (M=5.60; 79% boys) with oppositional defiant/conduct disorder, and their parents. Clinicians, teachers, and parents reported on dimensions of child behavior, and parental reports of family dysfunction and direct observations of parental warmth/responsiveness assessed quality of family relationships. Results from multiple regression analysis showed that, over and above the effects of child conduct problem severity and quality of family relationships, both ASD symptoms and CU traits were uniquely associated with deficits in cognitive empathy. Moreover, CU traits demonstrated an independent association with affective empathy, and this relationship was moderated by ASD symptoms. That is, there was a stronger negative association between CU traits and affective empathy at higher versus lower levels of ASD symptoms. These findings suggest including both CU traits and ASD-related social impairments in models delineating the atypical development of empathy in children with conduct problems.

Callous-Unemotional Traits, Proactive Aggression, and Treatment Outcomes of Aggressive Children With Attention-Deficit/Hyperactivity Disorder

Stimulant treatment improves impulse control among children with attention-deficit/hyperactivity disorder (ADHD). Decreased aggression often accompanies stimulant pharmacotherapy, suggesting that impulsiveness is integral to aggressive behavior in these children. However, children with high callous-unemotional (CU) traits and proactive aggression may benefit less from ADHD pharmacotherapy, because their aggressive behavior seems more purposeful and deliberate. This study's objective was to determine whether pretreatment CU traits and proactive aggression affect treatment outcomes among aggressive children with ADHD receiving stimulant monotherapy. We implemented a stimulant optimization protocol with 160 children 6 to 13 years of age (mean [SD] age of 9.31 [2.02] years; 78.75% male) with ADHD, oppositional defiant or conduct disorder, and significant aggressive behavior. Family-focused behavioral intervention was provided concurrently. The primary outcome was the Retrospective Modified Overt Aggression Scale. The Antisocial Process Screening Device and the Aggression Scale, also completed by parents, measured CU traits and proactive aggression, respectively. Analyses examined moderating effects of CU traits and proactive aggression on outcomes. In all, 82 children (51%) experienced remission of aggressive behavior. Neither CU traits nor proactive aggression predicted remission (CU traits: odds ratio [OR] = 0.94, 95% CI = 0.80-1.11; proactive aggression, OR = 1.05, 95% CI = 0.86-1.29). Children whose overall aggression remitted showed decreases in CU traits (effect size = -0.379, 95% CI = -0.60 to -0.16) and proactive aggression (effect size = -0.463, 95% CI = -0.69 to -0.23). Findings suggest that pretreatment CU traits and proactive aggression do not forecast worse outcomes for aggressive children with ADHD receiving optimized stimulant pharmacotherapy. With such treatment, CU traits and proactive aggression may decline alongside other behavioral improvements. Clinical trial registration information--Medication Strategies for Treating Aggressive Behavior in Youth With Attention Deficit Hyperactivity Disorder; http://clinicaltrials.gov/; NCT00228046; and Effectiveness of Combined Medication Treatment for Aggression in Children With Attention Deficit With Hyperactivity Disorder (The SPICY Study); http://clinicaltrials.gov/; NCT00794625.