Low Levels Of Callous-unemotional Traits Research Articles

Parenting boys with conduct problems and callous-unemotional traits: parent and child perspectives

Parenting children with conduct problems (CP) is challenging, yet very little research has examined parenting using both quantitative and qualitative methods, from the perspective of the child and their parent/caregiver, and separately for those with high vs. low levels of callous-unemotional traits (HCU vs. LCU). One hundred and forty-six boys aged 11–16 [Typically developing (TD) n = 31; CP/HCU n = 35; CP/LCU n = 35] and their parents/caregivers completed the Alabama Parenting Questionnaire and provided a written qualitative statement describing their respective experiences of parenting/being parented. Parents/caregivers of CP/HCU boys reported more difficulty with child monitoring and supervision than parents of TD boys. This was echoed in qualitative reports of parents of CP/HCU boys reporting concerns regarding their child’s safety. Parents/caregivers of both groups of CP boys reported more inconsistent discipline than parents of TD boys. Parental qualitative descriptions of challenging behavior in CP/HCU boys, and difficulties with setting boundaries and motivating CP/LCU boys, provided further insight to the potential triggers for inconsistent discipline. Qualitative reports from boys with CP indicated that they understood the parenting challenges their parents/caregivers faced. These findings replicate and extend previous work on the associations between parenting and CP. Children with CP/HCU and CP/LCU show some commonalities and differences in their parenting experiences and CP children and their parents/caregivers do not necessarily share all the same perceptions or concerns. CP interventions often involve parent/family engagement and this research highlights the continued importance of examining both parent and child perspectives.

Social information use in adolescents with conduct problems and varying levels of callous-unemotional traits.

Adolescents with conduct problems (CP) are characterised by difficulties with social relationships and display atypical social cognition, such as when interpreting emotional expressions or engaging in social problem-solving. One important aspect of social cognition that warrants investigation is the degree to which these adolescents factor others' views into their already held beliefs, and strategies used to do so. Effective social information use enables attunement to social environment, cooperation, and social problem-solving. Difficulties in this regard could contribute to problems in social interactions in adolescents with CP, and may vary with adolescents' high (CP/HCU) versus low levels of callous-unemotional traits (CP/LCU). We compared social information use in boys (11-16years) with CP/HCU (n=32), CP/LCU (n=31) and typically developing (TD) peers (n=45), matched for IQ. Participants provided estimates of numbers of animals on a screen, saw another adolescent's estimate, and could adjust their initial estimate. We compared two aspects of social information use: (1) degree of adjustment of initial estimate towards another's estimate and (2) strategy use when adjusting estimates. Degree of adjustment towards another's estimate did not vary across groups, but strategy use did. Adolescents with CP/LCU compromised less following social information than TD peers. Findings suggest that while adolescents with CP are able to take social information into account, those with CP/LCU use this information in a way that differs from other groups and could be less efficient. This warrants further systematic investigation as it could represent a target for behaviour management strategies. Overall, this study highlights the need for more research delineating the social-cognitive profile of adolescents with CP/LCU.

Machine learning classification of conduct disorder with high versus low levels of callous-unemotional traits based on facial emotion recognition abilities

Conduct disorder (CD) with high levels of callous-unemotional traits (CD/HCU) has been theoretically linked to specific difficulties with fear and sadness recognition, in contrast to CD with low levels of callous-unemotional traits (CD/LCU). However, experimental evidence for this distinction is mixed, and it is unclear whether these difficulties are a reliable marker of CD/HCU compared to CD/LCU. In a large sample (N = 1263, 9–18 years), we combined univariate analyses and machine learning classifiers to investigate whether CD/HCU is associated with disproportionate difficulties with fear and sadness recognition over other emotions, and whether such difficulties are a reliable individual-level marker of CD/HCU. We observed similar emotion recognition abilities in CD/HCU and CD/LCU. The CD/HCU group underperformed relative to typically developing (TD) youths, but difficulties were not specific to fear or sadness. Classifiers did not distinguish between youths with CD/HCU versus CD/LCU (52% accuracy), although youths with CD/HCU and CD/LCU were reliably distinguished from TD youths (64% and 60%, respectively). In the subset of classifiers that performed well for youths with CD/HCU, fear and sadness were the most relevant emotions for distinguishing them from youths with CD/LCU and TD youths, respectively. We conclude that non-specific emotion recognition difficulties are common in CD/HCU, but are not reliable individual-level markers of CD/HCU versus CD/LCU. These findings highlight that a reduced ability to recognise facial expressions of distress should not be assumed to be a core feature of CD/HCU.

Neurocognitive abilities associated with antisocial behavior with and without callous-unemotional traits in a community sample.

Antisocial behavior (aggression, rule breaking) is associated with lower intelligence and executive function deficits. Research has not clarified whether these associations differ with the presence of callous-unemotional (CU) traits, particularly within levels of antisocial behavior observed in the community. We examined whether antisocial behavior and CU traits were differentially associated with intelligence and executive function metrics in 474 adolescent twins (Mean age = 14.18; SD = 2.20) sampled from birth records to represent youth in the community living in neighborhoods with above average levels of poverty. Intelligence was assessed using standardized scores from the Shipley-2. Executive function was assessed using Go/No-Go and Stop Signal tasks. Neither antisocial behavior, nor CU traits alone, were associated with cognitive functioning when accounting for demographic factors. However, antisocial behavior and CU traits interacted to predict reaction time variability. At low levels of CU traits, antisocial behavior was associated with higher reaction time variability (traditionally thought to reflect worse sustained attention). At high levels of CU traits, antisocial behavior was associated with lower reaction time variability (thought to reflect better sustained attention). Elevated antisocial behavior and CU traits may be characterized by a distinct neurocognitive profile compared to elevated antisocial behavior in isolation. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Modulation of Amygdala Response by Cognitive Conflict in Adolescents with Conduct Problems and Varying Levels of CU Traits

Adolescents with conduct problems and low callous-unemotional traits are characterised by high levels of reactive aggression. Prior studies suggest that they can have exaggerated neural and behavioural responses to negative emotional stimuli, accompanied by compromised affect regulation and atypical engagement of prefrontal areas during cognitive control. This pattern may in part explain their symptoms. Clarifying how neurocognitive responses to negative emotional stimuli can be modulated in this group has potential translational relevance. We present fMRI data from a cognitive conflict task in which the requirement to visually scan emotional (vs. calm) faces was held constant across low and high levels of cognitive conflict. Participants were 17 adolescent males with conduct problems and low levels of callous-unemotional traits (CP/LCU); 17 adolescents with conduct problems and high levels of callous-unemotional traits (CP/HCU, who typically show blunted reactivity to fear), and 18 typically developing controls (age range 10–16). Control participants showed typical attenuation of amygdala response to fear relative to calm faces under high (relative to low) conflict, replicating previous findings in a healthy adult sample. In contrast, children with CP/LCU showed a reduced (left amygdala) or reversed (right amygdala) attenuation effect under high cognitive conflict conditions. Children with CP/HCU did not differ from controls. Findings suggest atypical modulation of amygdala response as a function of task demands, and raise the possibility that those with CP/LCU are unable to implement typical regulation of amygdala response when cognitive task demands are high.

Clarifying the Link Between Amygdala Functioning During Emotion Processing and Antisocial Behaviors Versus Callous-Unemotional Traits Within a Population-Based Community Sample.

Prominent theories suggest that disruptions in amygdala reactivity and connectivity when processing emotional cues are key to the etiology of youth antisocial behavior (AB) and that these associations may be dependent on co-occurring levels of callous-unemotional (CU) traits. We examined the associations among AB, CU traits, and amygdala reactivity and functional connectivity while viewing emotional faces (fearful, angry, sad, happy) in 165 adolescents (46% male; 73.3% African American) from a representative, predominantly low-income community sample. AB was associated with increased amygdala activation in response to all emotions and was associated with greater amygdala reactivity to emotion only at low levels of CU traits. AB and CU traits were also associated with distinct patterns of amygdala connectivity. These findings demonstrate that AB-related deficits in amygdala functioning may extend across all emotions and highlight the need for further research on amygdala connectivity during emotion processing in relation to AB and CU traits within community populations.

Thinking about Others\u2019 Minds: Mental State Inference in Boys with Conduct Problems and Callous-Unemotional Traits

Children with conduct problems (CP) and high levels of callous-unemotional traits (CP/HCU) have been found to have an intact ability to represent other minds, however, they behave in ways that indicate a reduced propensity to consider other people’s thoughts and feelings. Here we report findings from three tasks assessing different aspects of mentalising in 81 boys aged 11–16 [Typically developing (TD) n = 27; CP/HCU n = 28; CP and low levels of callous-unemotional traits (CP/LCU) n = 26]. Participants completed the Movie Assessment of Social Cognition (MASC), a task assessing ability/propensity to incorporate judgements concerning an individual’s mind into mental state inference; provided a written description of a good friend to assess mind-mindedness; and completed the Social Judgement Task (SJT), a new measure assessing mentalising about antisocial actions. Boys with CP/HCU had more difficulty in accurately inferring others’ mental states in the MASC than TD and CP/LCU boys. There were no group differences in the number of mind-related comments as assessed by the mind-mindedness protocol or in responses to the SJT task. These findings suggest that although the ability to represent mental states is intact, CP/HCU boys are less likely to update mental state inferences as a function of different minds.

Emotion versus cognition: differential pathways to theory of mind for children with high versus low callous-unemotional traits.

Theory of mind (ToM) serves as a foundation for developing social cognition. Developmental theory suggests that early emotion understanding supports the development of ToM, but few studies have tested this question within longitudinal designs. Additionally, children with callous-unemotional (CU) traits directly challenge this theory as they appear to develop intact ToM despite deficits in emotion understanding. Inhibitory control is proposed as one possible compensatory mechanism for ToM development in children with high CU traits. We examined emotion understanding and inhibitory control at age 3 as predictors of ToM at age 6 and tested whether these pathways were different in children with high versus low levels of CU traits. Multimethod data included observations of child emotion understanding and inhibitory control and parent reports of CU traits drawn from a prospective, longitudinal study (N=240, 48% female). Consistent with our hypothesis, emotion understanding at age 3 significantly predicted ToM at age 6 only for children with low CU traits. Although there was a significant interaction between inhibitory control and CU traits in relation to later ToM, the simple slopes were not significant. We find prospective longitudinal evidence that emotion understanding is a developmental precursor of ToM. However, this pathway was not evident in children with high CU traits. Future research is needed to further explore potential mechanisms by which children with CU traits develop ToM with a potential focus on higher-order cognitive skills.

Empathy in Youths with Conduct Disorder and Callous-Unemotional Traits.

Previous studies indicated that a lack of empathy could be considered the core feature of callous-unemotional (CU) traits in children and adolescents. The present study is aimed at exploring relationships among CU traits, cognitive and emotional dimensions of empathy, emotion recognition (basic, social, and complex emotions), and history of maltreatment in a sample of youths with conduct disorder diagnosis. The sample consisted of 60 Italian male patients (age range 11-17 years, mean age 13.27 ± 1.90 years) referred to the Department of Child and Adolescent Psychiatry (Pisa, Italy). In the whole sample, the levels of CU traits were significantly negatively associated with both cognitive and emotional dimensions of empathy; in addition, the CD patients with high levels of CU traits show significantly lower levels of empathic concern compared to those with low levels of CU traits. Clinical implications of the findings are discussed.

Callous unemotional traits and the relationship between aggressive parenting practices and conduct problems in Singaporean families

Research into parenting influences on child conduct problems in Asian countries has been limited compared to that conducted in Western countries, especially with regard to interplay between parenting and callous unemotional (CU) traits (e.g., lack of guilt and empathy). This study examined associations between dimensions of aggressive parenting practices (psychological aggression, mild and severe physical aggression), dimensions of child aggression (proactive, reactive), and child CU traits, in Singapore. Participants were children and adolescents with clinic-referred externalizing problems (N = 282; 87.6% boys), aged 7–16 years. Mild and severe parental physical aggression was found to be uniquely associated with children’s proactive aggression, whereas parental psychological aggression was uniquely associated with both proactive and reactive aggression. Consistent with previous evidence regarding CU traits as moderators of the relationship between negative parenting and child conduct problems, physically aggressive parenting was found to be more strongly associated with children’s proactive aggression among children with low levels of CU traits, than those with high CU traits. These findings support the need for ongoing research into CU traits in Asian cultures, focused on heterogeneous risk pathways to antisocial behavior and individual differences in response to family-based interventions.

Altered White-Matter Microstructure in Conduct Disorder Is Specifically Associated with Elevated Callous-Unemotional Traits

Adolescents with conduct disorder (CD) and elevated callous-unemotional (CU) traits have been reported to present with a more severe and persistent pattern of antisocial behaviour than those with low levels of CU traits. However, relatively few studies have investigated whether there are differences in brain structure between these subgroups.We acquired diffusion tensor imaging data and used tract-based spatial statistics (TBSS) to compare adolescents with CD and high levels of CU traits (CD/CU+; n = 18, CD and low levels of CU traits (CD/CU-; n = 17) and healthy controls (HC; n = 32) on measures of fractional anisotropy (FA), axial (AD), radial (RD) and mean (MD) diffusivity. Compared to CD/CU- adolescents, those with CD/CU+ presented increased FA and reduced RD and MD (lower diffusivity) in several tracts including: body and splenium of the corpus callosum, right inferior longitudinal fasciculus, ILF; right inferior fronto-occipital fasciculus, IFOF; left superior longitudinal fasciculus, SLF; left cerebral peduncle, bilateral internal capsule, left superior and posterior corona radiata, bilateral thalamic radiation and left external capsule. In addition, relative to CD/CU- individuals, adolescents with CD/CU+ showed lower diffusivity (indexed by reduced RD and MD) in left uncinate fasciculus and bilateral fornix. Finally, relative to healthy controls, CD/CU+ individuals showed lower diffusivity (reduced RD) in the genu and body of the corpus callosum and left anterior corona radiata. These results suggest that CD/CU+ individuals present with white-matter microstructural abnormalities compared to both CD/CU- individuals and age-matched healthy controls. This finding is consistent with emerging evidence suggesting that CD/CU+ represents a distinct subtype of CD, and illustrates the importance of accounting for heterogeneity within CD populations.

Positive Parenting and Callous-Unemotional Traits: Their Association With School Behavior Problems in Young Children

The current study tested the associations of both positive (i.e., warm and responsive) and negative (i.e., harsh and inconsistent) aspects of parenting with callous-unemotional (CU) traits and conduct problems. Caregivers and teachers of 92 ethnically diverse (33% African American) kindergarten students (61% female) were recruited to complete a series of survey measures. Students’ average age was 6.2 (SD = 0.42) years. Parent report of positive parenting practices, but not negative parenting practices, was associated with teacher report of conduct problems. Further, positive parenting interacted with CU traits in their association with conduct problems. Parental use of positive reinforcement was more strongly negatively related to conduct problems for youth with high levels of CU traits, whereas parent–child cooperation was positively related to conduct problems only for youth with low levels of CU traits. Finally, only parental warmth was negatively correlated with CU traits after controlling for level of conduct problems. Results were generally not moderated by the child’s gender or ethnicity. These findings highlight the importance of positive parenting practices for understanding CU traits and as potential targets in clinical interventions to treat children who show elevated levels of these traits.

Predicting Risky Sexual Behavior: the Unique and Interactive Roles of Childhood Conduct Disorder Symptoms and Callous-Unemotional Traits.

Conduct disorder (CD) symptoms and callous-unemotional (CU) traits have been shown to be uniquely associated with risky sexual behavior (RSB) in adolescence and early adulthood, yet their interactive role in predicting RSB remains largely unknown. This study aimed to investigate the predictive value of CD symptoms and CU traits, as well as their interaction, on several RSB outcomes in adolescence and early adulthood. A total of 683 participants (41.7% female, 47.4% African American) were followed annually and self-reported age of first sexual intercourse, frequency of condom use, pregnancy, contraction of sexually transmitted infections, and engagement in sexual solicitation from grade 7 to 2-years post-high school. CD symptoms predicted age of first sexual intercourse, condom use, and sexual solicitation. CU traits predicted age of first sexual intercourse and pregnancy. Their interaction predicted a composite score of these RSBs such that CD symptoms positively predicted the composite score among those with high levels of CU traits but not among those with low levels of CU traits. The current findings provide information regarding the importance of both CD symptoms and CU traits in understanding adolescent and early adulthood RSB, as well as the benefits of examining multiple RSB outcomes during this developmental period. These findings have implications for the development and implementation of preventive efforts to target these risky behaviors among adolescents and young adults.

Predicting aggression in late adolescent romantic relationships: A short-term longitudinal study

This study sought to prospectively predict aggression in the romantic relationships of 1180 college students from the United States (807 females; 373 males) over the course of two months with a set of intrapersonal risk and protective factors, including personality characteristics that rarely have been examined in this population. After accounting for prior dating aggression, perpetration of verbal aggression was predicted uniquely by aggressive attitudes, emotion regulation, and for females, narcissism. Perpetration of physical aggression was predicted by aggressive attitudes, but only at low levels of emotion regulation, and the interaction of callous-unemotional traits, emotion regulation, and gender: males with low levels of callous-unemotional traits perpetrated less physical aggression when they reported greater emotion regulation. These findings are among the first to show that personality traits and emotion regulation prospectively predict partner aggression in late adolescence and suggest mechanisms for continuity in interpersonal aggression from early adolescence to adulthood.

Adolescent Callous-Unemotional Traits and Parental Knowledge as Predictors of Unprotected Sex Among Youth

Risky sexual behavior among adolescents is common and results in many negative consequences. The present study investigated longitudinal predictors of adolescents' likelihood of engaging in unprotected sexual intercourse. Parental knowledge, or the extent to which parents know about their children's activities, whereabouts, and friendships, is a robust predictor of youth risk behavior, including risky sexual behavior. However, parenting practices are typically less potent as predictors of subsequent behavior among youth with high levels of callous-unemotional (CU) traits. We conducted three logistic regression models, each of which examined parental knowledge in a different way (through child report, parent report, and a discrepancy score), allowing us to examine parental knowledge, CU traits, and their interaction as predictors of adolescents' subsequent engagement in sex without a condom. Results indicated that adolescents who perceived their parents to possess greater knowledge were less likely to engage in unprotected sex. Higher parent report of parental knowledge was also related to decreased likelihood of engaging in unprotected sex, but only for adolescents with high levels of CU traits. In addition, greater discrepancy between parent and adolescent reports of parental knowledge was related to increased likelihood of engaging in unprotected sex, but only for adolescents with low levels of CU traits. Results highlight the importance of considering both parent and adolescent perceptions of parental knowledge and have important implications for prevention and intervention efforts.

Emotional attentional capture in children with conduct problems: the role of callous-unemotional traits.

Objective: Appropriate reactivity to emotional facial expressions, even if these are seen whilst we are engaged in another activity, is critical for successful social interaction. Children with conduct problems (CP) and high levels of callous-unemotional (CU) traits are characterized by blunted reactivity to other people's emotions, while children with CP and low levels of CU traits can over-react to perceived emotional threat. No study to date has compared children with CP and high vs. low levels of CU traits to typically developing (TD) children or each other, using a task that assesses attentional capture by irrelevant emotional faces.Method: All participants performed an attentional capture task in which they were asked to judge the orientation of a single male face that was displayed simultaneously with two female faces. Three types of trials were presented, trials with all neutral faces, trials with an emotional distractor face and trials with an emotional target face. Fifteen boys with CP and high levels of CU traits, 17 boys with CP and low levels of CU traits and 17 age and ability matched TD boys were included in the final study sample.Results: Compared to TD children and children with low levels of CU traits, children with CP and high levels of CU traits showed reduced attentional capture by irrelevant emotional faces.Conclusions: This study is the first to demonstrate a different pattern in emotional attentional capture in children with CP depending on their level of CU traits.

Revisiting the treatment of conduct problems in children with callous-unemotional traits

This study examined whether the diminished treatment response previously reported for children with conduct problems and high levels of callous-unemotional (CU) traits is evident when these traits are indexed using multi-informant data collected from mothers, fathers, and teachers. It also tested whether treatment outcomes associated with CU traits are independent of overlap between CU traits and autism spectrum disorder (ASD) symptoms. Diagnostic data on oppositional defiant disorder (ODD) severity were collected pre-treatment (time 1) and at 6-month follow-up (time 2) in a sample of children (N = 95; 67 boys, 28 girls) aged 3-9 years with clinic-referred conduct problems and comorbid symptoms in a range of diagnostic domains. Time 1 measures of CU traits and ASD symptoms were tested as predictors of time 2 ODD severity using structural equation modeling, with multi-informant ratings of CU traits modeled as a single latent variable. Compared to children with low levels of CU traits, those with high levels exhibited more severe ODD symptoms at follow-up (β = 0.33, SE = 0.08, p < 0.05), after controlling for pre-treatment severity, socio-economic status, other demographics (age, gender), and parameters of treatment (number of treatment sessions, medication status). Although CU traits and ASD symptoms were positively correlated, ASD symptoms showed no association with change in ODD severity from pre-treatment to follow-up. Likewise, the association between CU traits and ODD outcomes held when controlling for covariation between CU traits and ASD symptoms. Our findings replicate previous evidence that CU traits are uniquely associated with poor clinical outcomes among children treated for conduct problems, and show for the first time that this association is not accounted for by symptoms of ASD.

Amygdala Response to Preattentive Masked Fear in Children With Conduct Problems: The Role of Callous-Unemotional Traits

In children with conduct problems, high levels of callous-unemotional traits are associated with amygdala hypoactivity to consciously perceived fear, while low levels of callous-unemotional traits may be associated with amygdala hyperactivity. Behavioral data suggest that fear processing deficits in children with high callous-unemotional traits may extend to stimuli presented below conscious awareness (preattentively). The authors investigated the neural basis of this effect. Amygdala involvement was predicted on the basis of its role in preattentive affective processing in healthy adults and its dysfunction in previous studies of conduct problems. Functional MRI was used to measure neural responses to fearful and calm faces presented preattentively (for 17 ms followed by backward masking) in boys with conduct problems and high callous-unemotional traits (N=15), conduct problems and low callous-unemotional traits (N=15), and typically developing comparison boys (N=16). Amygdala response to fearful and calm faces was predicted to differentiate groups, with the greatest response in boys with conduct problems and low callous-unemotional traits and the lowest in boys with conduct problems and high callous-unemotional traits. In the right amygdala, a greater amygdala response was seen in boys with conduct problems and low callous-unemotional traits than in those with high callous-unemotional traits. The findings were not explained by symptom levels of conduct disorder, attention-deficit hyperactivity disorder, anxiety, or depression. These data demonstrate differential amygdala activity to preattentively presented fear in children with conduct problems grouped by callous-unemotional traits, with high levels associated with lower amygdala reactivity. The study's findings complement increasing evidence suggesting that callous-unemotional traits are an important specifier in the classification of children with conduct problems.

Cortisol, callous-unemotional traits, and pathways to antisocial behavior

Two decades of research has implicated the hypothalamic-pituitary-adrenal (HPA) axis in the development of antisocial behavior in children. However, findings regarding the association between cortisol and antisocial behavior have been largely inconsistent, and the role of the HPA axis in relation to broader etiological processes remains unclear. We examine evidence that the role of the HPA axis in the development of antisocial behavior may differ across subgroups of children. A meta-analysis has supported the prediction that low levels of cortisol are associated with risk for childhood antisocial behavior, but the relationship is weaker than previously assumed. Recent studies suggest the association between cortisol levels and antisocial behavior may vary depending on type of antisocial behavior, patterns of internalizing comorbidity, and early environmental adversity. The findings are consistent with evidence that two early-onset pathways to antisocial behavior can be distinguished based on the presence or absence of callous-unemotional traits. We speculate that early adversity is important to the development of chronic antisocial behavior in children with low levels of callous-unemotional traits and HPA-axis hyperactivity, but that high levels of callous-unemotional traits and HPA-axis hypoactivity characterize a particularly severe subgroup, for whom antisocial behavior develops somewhat independently of adversity.